AUTHOR=Lopes Maria Antonieta Albanez A. de M. , Campos Carlos M. , Rosa Vitor Emer Egypto , Sampaio Roney O. , Morais Thamara C. , de Brito Júnior Fábio Sândoli , Vieira Marcelo L. C. , Mathias Wilson , Fernandes Joao Ricardo Cordeiro , de Santis Antonio , Santos Luciano de Moura , Rochitte Carlos E. , Capodanno Davide , Tamburino Corrado , Abizaid Alexandre , Tarasoutchi Flavio 

TITLE=Multimodality imaging methods and systemic biomarkers in classical low-flow low-gradient aortic stenosis: Key findings for risk stratification

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=10

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1149613

DOI=10.3389/fcvm.2023.1149613

ISSN=2297-055X

ABSTRACT=<sec><title>Objectives</title><p>The aim of the present study is to assess multimodality imaging findings according to systemic biomarkers, high-sensitivity troponin I (hsTnI) and B-type natriuretic peptide (BNP) levels, in low-flow, low-gradient aortic stenosis (LFLG-AS).</p></sec><sec><title>Background</title><p>Elevated levels of BNP and hsTnI have been related with poor prognosis in patients with LFLG-AS.</p></sec><sec><title>Methods</title><p>Prospective study with LFLG-AS patients that underwent hsTnI, BNP, coronary angiography, cardiac magnetic resonance (CMR) with T1 mapping, echocardiogram and dobutamine stress echocardiogram. Patients were divided into 3 groups according to BNP and hsTnI levels: Group 1 (<italic>n</italic> = 17) when BNP and hsTnI levels were below median [BNP &lt; 1.98 fold upper reference limit (URL) and hsTnI &lt; 1.8 fold URL]; Group 2 (<italic>n</italic> = 14) when BNP or hsTnI were higher than median; and Group 3 (<italic>n</italic> = 18) when both hsTnI and BNP were higher than median.</p></sec><sec><title>Results</title><p>49 patients included in 3 groups. Clinical characteristics (including risk scores) were similar among groups. Group 3 patients had lower valvuloarterial impedance (<italic>P</italic> = 0.03) and lower left ventricular ejection fraction (<italic>P</italic> = 0.02) by echocardiogram. CMR identified a progressive increase of right and left ventricular chamber from Group 1 to Group 3, and worsening of left ventricular ejection fraction (EF) (40 [31–47] vs. 32 [29–41] vs. 26 [19–33]%; <italic>p</italic> &lt; 0.01) and right ventricular EF (62 [53–69] vs. 51 [35–63] vs. 30 [24–46]%; <italic>p</italic> &lt; 0.01). Besides, there was a marked increase in myocardial fibrosis assessed by extracellular volume fraction (ECV) (28.4 [24.8–30.7] vs. 28.2 [26.9–34.5] vs. 31.8 [28.9–35.5]%; <italic>p</italic> = 0.03) and indexed ECV (iECV) (28.7 [21.2–39.1] vs. 28.8 [25.4–39.9] vs. 44.2 [36.4–51.2] ml/m<sup>2</sup>, respectively; <italic>p</italic> &lt; 0.01) from Group 1 to Group 3.</p></sec><sec><title>Conclusions</title><p>Higher levels of BNP and hsTnI in LFLG-AS patients are associated with worse multi-modality evidence of cardiac remodeling and fibrosis.</p></sec>