The relationship between myocardial fibrosis and left ventricular remodeling following aortic valve replacement

Serik Aitaliyev 1 * , Egle Rumbinaitė 2, Rokas Nekrošius 1, Vytenis Keturakis 1, Rimantas Benetis 1
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1 Department of Cardiac, Thoracic and Vascular Surgery, Hospital of Lithuanian University of Health Sciences, Kauno Klinikos, Medical Academy, Lithuanian University of Health Sciences
2 Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences
* Corresponding Author
J CLIN MED KAZ, Volume 18, Issue 4, pp. 39-45. https://doi.org/10.23950/jcmk/11039
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ABSTRACT

Aim. Aortic valve diseases are associated with myocardial fibrosis. The relationship between severity of myocardial fibrosis and left ventricular mass reduction (LVMR) after aortic valve replacement (AVR) still needs to be elucidated.
Methods. In a single-center, retrospective trial, 130 patients underwent AVR with/without concomitant surgery. The study population was divided by etiology into aortic stenosis (AS) and aortic regurgitation (AR) groups. LV end-diastolic diameter, LV septal and posterior thicknesses, LV mass, and aortic annulus were obtained in all study patients. Left ventricular mass regression index (iLVMR) was found by the difference between preoperative iLVM and follow-up iLVM.  iLVMR in months was calculated by divided iLVMR on the number of months before follow-up visit. Myocardial tissue was embedded in paraffin, and sectioned into 4 µm slices for histological staining (picrosirius red) and scanning. The fraction of myocardial volume occupied by collagen tissue was determined.
Results. The left ventricular remodeling of AS and AR patients is presented in Table 3. There was significant LV mass reduction in both aortic valve disease groups in the follow-up period (AS group, p < 0.001; AR group, p < 0.05). The number of LVH cases decreased in both groups in the follow-up period (AS group, p < 0.001; AR group, p < 0.05). In Post-AVR period the ejection fraction of LV did not improve in the AS group, compare to AR group (p<0.05). In both groups number of patients with impaired LV EF was increased in Post-AVR period, but not significantly.  Moreover, the LV septal thickness, and iLVEDD significantly decreased in the AS group (p<0.001 and p<0.001), compared to the AR group (p=NS, p<0.05).
We did not found correlations between MF and LVM in preoperative, and follow-up periods for AS and AR groups. Moreover, MF did not correlate significantly to iLVMR and iLVMR in months. A significant correlation exists in AS patients between MF and preoperative iLVEDD (r = 0.21, p = 0.04).
Conclusion. The LVM reduction was observed in both AS and AR groups. LVM of AS group recovered more quickly than that of AR group. In our study MF does not affect LVM regression. Large cohort of patients with myocardial biopsies and long-term follow-up are needed to access the impact of the MF on the LVMR.
Keywords: aortic valve, myocardial fibrosis, aortic valve replacement, left ventricular mass regression

CITATION

Aitaliyev S, Rumbinaitė E, Nekrošius R, Keturakis V, Benetis R. The relationship between myocardial fibrosis and left ventricular remodeling following aortic valve replacement. J CLIN MED KAZ. 2021;18(4):39-45. https://doi.org/10.23950/jcmk/11039

REFERENCES

  • Gavina C, Falcão-Pires I, Pinho P, Manso MC, Gonçalves A, Rocha-Gonçalves F, et al. Relevance of residual left ventricular hypertrophy after surgery for isolated aortic stenosis. European Journal of Cardio-thoracic Surgery. 2016. CrossRef: https://doi.org/10.1093/ejcts/ezv240.
  • Azevedo CF, Nigri M, Higuchi ML, Pomerantzeff PM, Spina GS, Sampaio RO, et al. Prognostic significance of myocardial fibrosis quantification by histopathology and magnetic resonance imaging in patients with severe aortic valve disease. Journal of the American College of Cardiology. 2010;56(4):278-287. CrossRef: https://doi.org/10.1016/j.jacc.2009.12.074.
  • Schwartzkopff B, Frenzel H, Diekerhoff J, Betz P, Flasshove M, Schulte HD, et al. Morphometric investigation of human myocardium in arterial hypertension and valvular aortic stenosis. European Heart Journal. 1992. CrossRef: https://doi.org/10.1093/eurheartj/13.suppl_d.17
  • Treibel TA, Kozor R, Schofield R, Benedetti G, Fontana M, Bhuva AN, et al. Reverse Myocardial Remodeling Following Valve Replacement in Patients With Aortic Stenosis. Journal of the American College of Cardiology. 2018;71(8):860-871. CrossRef: https://doi.org/10.1016/j.jacc.2017.12.035.
  • Vassiliou VS, Perperoglou A, Raphael CE, Joshi S, Malley T, Everett R, et al. Midwall Fibrosis and 5-Year Outcome in Moderate and Severe Aortic Stenosis. Journal of the American College of Cardiology. 2017;69(13):1755-1756. CrossRef: https://doi.org/10.1016/j.jacc.2017.01.034.
  • Weidemann F, Herrmann S, Störk S, Niemann M, Frantz S, Lange V, et al. Impact of myocardial fibrosis in patients with symptomatic severe aortic stenosis. Circulation. 2009;120(7):577-584. CrossRef: https://doi.org/10.1161/CIRCULATIONAHA.108.847772.
  • Chang HW, Kim K-H, Kim JS, Kim K-H, Kim Y-J. Relationship between morphologic features of myocardial tissue and left ventricular function in patients with aortic valve disease and left ventricular hypertrophy. The Journal of heart valve disease. 2013;22(4):476-483
  • Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American society of echocardiography and the European association of cardiovascular imaging. European Heart Journal Cardiovascular Imaging. 2015. CrossRef: https://doi.org/10.1093/ehjci/jev014.
  • Pibarot P, Dumesnil JG. Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its prevention. 2000.
  • Tanaka M, Fujiwara H, Onodera T, Wu DJ, Hamashima Y, Kawai C. Quantitative analysis of myocardial fibrosis in normals, hypertensive hearts, and hypertrophic cardiomyopathy. Heart. 1986;55(6):575-581. CrossRef: https://doi.org/10.1136/hrt.55.6.575.
  • Bates ER. Treatment options in severe aortic stenosis. Circulation. 2011;124(3):355-359. CrossRef: https://doi.org/10.1161/CIRCULATIONAHA.110.974204.
  • Chiappini B, Camurri N, Loforte A, Di Marco L, Di Bartolomeo R, Marinelli G. Outcome after aortic valve replacement in octogenarians. Annals of Thoracic Surgery. 2004. CrossRef: https://doi.org/10.1016/j.athoracsur.2003.12.060.
  • Freeman RV, Otto CM. Spectrum of calcific aortic valve disease: Pathogenesis, disease progression, and treatment strategies. Circulation. 2005;111(24):3316-3326. CrossRef: https://doi.org/10.1161/CIRCULATIONAHA.104.486738.
  • Rajamannan NM, Bonow RO, Rahimtoola SH. Calcific aortic stenosis: An update. Nature Clinical Practice Cardiovascular Medicine. 2007;4(5):254-262. CrossRef: https://doi.org/10.1038/ncpcardio0827.
  • Stewart BF, Siscovick D, Lind BK, Gardin JM, Gottdiener JS, Smith VE, et al. Clinical factors associated with calcific aortic valve disease. Journal of the American College of Cardiology. 1997. CrossRef: https://doi.org/10.1016/S0735-1097(96)00563-3. P
  • Maurer G. Aortic regurgitation. 2006.
  • Supino PG, Borer JS, Preibisz J, Bornstein A. The Epidemiology of Valvular Heart Disease: a Growing Public Health Problem. 2006.
  • Flint N, Wunderlich NC, Shmueli H, Ben-Zekry S, Siegel RJ, Beigel R. Aortic Regurgitation. Current Cardiology Reports. 2019;21(7). CrossRef: https://doi.org/10.1007/s11886-019-1144-6.
  • You J, Wu J, Zhang Q, Ye Y, Wang S, Huang J, et al. Differential cardiac hypertrophy and signaling pathways in pressure versus volume overload. American Journal of Physiology - Heart and Circulatory Physiology. 2018;314(3):H552-H562. CrossRef: https://doi.org/10.1152/ajpheart.00212.2017.
  • Chuang ML, Gona P, Salton CJ, Yeon SB, Kissinger KV, Blease SJ, et al. Usefulness of the left ventricular myocardial contraction fraction in healthy men and women to predict cardiovascular morbidity and mortality. American Journal of Cardiology. 2012;109(10):1454-1458. CrossRef: https://doi.org/10.1016/j.amjcard.2012.01.357.
  • Capoulade R, Clavel MA, Mathieu P, Côté N, Dumesnil JG, Arsenault M, et al. Impact of hypertension and renin-angiotensin system inhibitors in aortic stenosis. European Journal of Clinical Investigation. 2013. CrossRef: https://doi.org/10.1111/eci.12169.
  • Verdecchia P, Angeli F, Achilli P, Castellani C, Broccatelli A, Gattobigio R, et al. Echocardiographic left ventricular hypertrophy in hypertension: Marker for future events or mediator of events? Current Opinion in Cardiology. 2007;22(4):329-334. CrossRef: https://doi.org/10.1097/HCO.0b013e3280ebb413.
  • Ali A, Patel A, Ali Z, Abu-Omar Y, Saeed A, Athanasiou T, et al. Enhanced left ventricular mass regression after aortic valve replacement in patients with aortic stenosis is associated with improved long-term survival. Journal of Thoracic and Cardiovascular Surgery. 2011;142(2):285-291. CrossRef: https://doi.org/10.1016/j.jtcvs.2010.08.084.
  • Lund O, Emmertsen K, Dørup I, Jensen FT, Flø C. Regression of left ventricular hypertrophy during 10 years after valve replacement for aortic stenosis is related to the preoperative risk profile. European Heart Journal. 2003;24(15):1437-1446. CrossRef: https://doi.org/10.1016/S0195-668X(03)00316-6.
  • Lamb HJ, Beyerbacht HP, Roos AD, Laarse AVD, Vliegen HW, Leujes F, et al. Left Ventricular Remodeling Early After Aortic Valve Replacement : Differential Effects on Diastolic Function in Aortic Valve Stenosis and Aortic Regurgitation. Journal of the American College of Cardiology. 2002;40(12):2182-2188. CrossRef: https://doi.org/10.1016/S0735-1097(02)02604-9.
  • Zhao Y. Effect of valve replacement for aortic stenosis on ventricular function2011.
  • Vollema EM, Singh GK, Prihadi EA, Regeer MV, Ewe SH, Ng ACT, et al. Time course of left ventricular remodelling and mechanics after aortic valve surgery : aortic stenosis vs . aortic regurgitation. 2020;31(2019):1105-1111. CrossRef: https://doi.org/10.1093/ehjci/jez049.
  • Une D, Mesana L, Chan V, Maklin M, Chan R, Masters RG, et al. Clinical impact of changes in left ventricular function after aortic valve replacement: Analysis from 3112 patients. Circulation. 2015;132(8):741-747. CrossRef: https://doi.org/10.1161/CIRCULATIONAHA.115.015371.
  • Frangogiannis NG. Cardiac fibrosis: Cell biological mechanisms, molecular pathways and therapeutic opportunities. Molecular Aspects of Medicine. 2019;65(July 2018):70-99. CrossRef: https://doi.org/10.1016/j.mam.2018.07.001.
  • Milano AD, Faggian G, Dodonov M, Golia G, Tomezzoli A, Bortolotti U, et al. Prognostic value of myocardial fibrosis in patients with severe aortic valve stenosis. Journal of Thoracic and Cardiovascular Surgery. 2012;144(4):830-837. CrossRef: https://doi.org/10.1016/j.jtcvs.2011.11.024.
  • Podlesnikar T, Delgado V, Bax JJ. Cardiovascular magnetic resonance imaging to assess myocardial fibrosis in valvular heart disease. International Journal of Cardiovascular Imaging. 2018;34(1):97-112. CrossRef: https://doi.org/10.1007/s10554-017-1195-y.
  • Petrov G, Regitz-Zagrosek V, Lehmkuhl E, Krabatsch T, Dunkel A, Dandel M, et al. Regression of myocardial hypertrophy after aortic valve replacement: Faster in women? Circulation. 2010;122(11 SUPPL. 1):23-28. CrossRef: https://doi.org/10.1161/CIRCULATIONAHA.109.927764.
  • Lee SP, Park SJ, Kim YJ, Chang SA, Park EA, Kim HK, et al. Early detection of subclinical ventricular deterioration in aortic stenosis with cardiovascular magnetic resonance and echocardiography. Journal of Cardiovascular Magnetic Resonance. 2013;15(1):1-1. CrossRef: https://doi.org/10.1186/1532-429X-15-72.
  • Díez J, Querejeta R, López B, González A, Larman M, Martínez Ubago JL. Losartan-dependent regression of myocardial fibrosis is associated with reduction of left ventricular chamber stiffness in hypertensive patients. Circulation. 2002. CrossRef: https://doi.org/10.1161/01.CIR.0000017264.66561.3D.
  • Dahl JS, Videbaek L, Poulsen MK, Pellikka PA, Veien K, Andersen LI, et al. Effect of candesartan treatment on left ventricular remodeling after aortic valve replacement for aortic stenosis. American Journal of Cardiology. 2010;106(5):713-719. CrossRef: https://doi.org/10.1016/j.amjcard.2010.04.028.
  • Linhartová K, Filipovský J, Čerbák R, Šterbáková G, Hanišová I, Beránek V. Severe aortic stenosis and its association with hypertension: Analysis of clinical and echocardiographic parameters. Blood Pressure. 2007. CrossRef: https://doi.org/10.1080/08037050701343241.
  • Helder MRK, Ugur M, Bavaria JE, Kshettry VR, Schaff HV. ACQUIRED CARDIOVASCULAR DISEASE : AORTIC VALVE The effect of postoperative medical treatment on left ventricular mass regression after aortic valve replacement. The Journal of Thoracic and Cardiovascular Surgery. 2015;149(3):781-786. CrossRef: https://doi.org/10.1016/j.jtcvs.2014.10.034.
  • Hall SA, Cigarroa CG, Marcoux L, Risser RC, Grayburn PA, Eichhorn EJ. Time course of improvement in left ventricular function, mass and geometry in patients with congestive heart failure treated with beta-adrenergic blockade. Journal of the American College of Cardiology. 1995. CrossRef: https://doi.org/10.1016/0735-1097(94)00543-Y.
  • Reiken S, Wehrens XHT, Vest JA, Barbone A, Klotz S, Mancini D, et al. β-blockers restore calcium release channel function and improve cardiac muscle performance in human heart failure. Circulation. 2003. CrossRef: https://doi.org/10.1161/01.CIR.0000068316.53218.49.