Myocardial steatosis and left ventricular contractile dysfunction in patients with severe aortic stenosis

Masliza Mahmod, Sacha Bull, Joseph J. Suttie, Nikhil Pal, Cameron Holloway, Sairia Dass, Saul G. Myerson, Jurgen E. Schneider, Ravi De Silva, Mario Petrou, Rana Sayeed, Stephen Westaby, Colin Clelland, Jane M. Francis, Houman Ashrafian, Theodoros D. Karamitsos, Stefan Neubauer

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Background-Aortic stenosis (AS) leads to left ventricular (LV) hypertrophy and dysfunction. We hypothesized that cardiac steatosis is involved in the pathophysiology and also assessed whether it is reversible after aortic valve replacement. Methods and Results-Thirty-nine patients with severe AS (symptomatic=25, asymptomatic=14) with normal LV ejection fraction and no significant coronary artery disease and 20 age- and sex-matched healthy controls underwent cardiac 1H-magnetic resonance spectroscopy and imaging for the determination of steatosis (myocardial triglyceride content) and cardiac function, including circumferential strain (measured by magnetic resonance tagging). Strain was lower in both symptomatic and asymptomatic AS (-16.4±2.5% and -18.1±2.9%, respectively, versus controls -20.7±2.0%, both P<0.05). Myocardial steatosis was found in both symptomatic and asymptomatic patients with AS (0.89±0.42% in symptomatic AS; 0.75±0.36% in asymptomatic AS versus controls 0.45±0.17, both P<0.05). Importantly, multivariable analysis indicated that steatosis was an independent correlate of impaired LV strain. Spectroscopic measurements of myocardial triglyceride content correlated significantly with histological analysis of biopsies obtained during aortic valve replacement. At 8.0±2.1 months after aortic valve replacement, steatosis and strain had recovered toward normal. Conclusions-Pronounced myocardial steatosis is present in severe AS, regardless of symptoms, and is independently associated with the degree of LV strain impairment. Myocardial triglyceride content measured by magnetic resonance spectroscopy correlates with histological quantification. Steatosis and strain impairment are reversible after aortic valve replacement. Our findings suggest a novel pathophysiological mechanism in AS, myocardial steatosis, which may be amenable to treatment, thus potentially delaying onset of LV dysfunction.

Original languageEnglish
Pages (from-to)808-816
Number of pages9
JournalCirculation: Cardiovascular Imaging
Volume6
Issue number5
DOIs
Publication statusPublished - Sep 2013
Externally publishedYes

Fingerprint

Aortic Valve Stenosis
Left Ventricular Dysfunction
Aortic Valve
Triglycerides
Magnetic Resonance Spectroscopy
Left Ventricular Hypertrophy
Stroke Volume
Coronary Artery Disease
Magnetic Resonance Imaging
Biopsy

Keywords

  • Aortic valve stenosis
  • Cardiac MRI
  • Myocardial steatosis
  • Spectroscopy
  • Strain

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Myocardial steatosis and left ventricular contractile dysfunction in patients with severe aortic stenosis. / Mahmod, Masliza; Bull, Sacha; Suttie, Joseph J.; Pal, Nikhil; Holloway, Cameron; Dass, Sairia; Myerson, Saul G.; Schneider, Jurgen E.; De Silva, Ravi; Petrou, Mario; Sayeed, Rana; Westaby, Stephen; Clelland, Colin; Francis, Jane M.; Ashrafian, Houman; Karamitsos, Theodoros D.; Neubauer, Stefan.

In: Circulation: Cardiovascular Imaging, Vol. 6, No. 5, 09.2013, p. 808-816.

Research output: Contribution to journalArticle

Mahmod, M, Bull, S, Suttie, JJ, Pal, N, Holloway, C, Dass, S, Myerson, SG, Schneider, JE, De Silva, R, Petrou, M, Sayeed, R, Westaby, S, Clelland, C, Francis, JM, Ashrafian, H, Karamitsos, TD & Neubauer, S 2013, 'Myocardial steatosis and left ventricular contractile dysfunction in patients with severe aortic stenosis', Circulation: Cardiovascular Imaging, vol. 6, no. 5, pp. 808-816. https://doi.org/10.1161/CIRCIMAGING.113.000559
Mahmod, Masliza ; Bull, Sacha ; Suttie, Joseph J. ; Pal, Nikhil ; Holloway, Cameron ; Dass, Sairia ; Myerson, Saul G. ; Schneider, Jurgen E. ; De Silva, Ravi ; Petrou, Mario ; Sayeed, Rana ; Westaby, Stephen ; Clelland, Colin ; Francis, Jane M. ; Ashrafian, Houman ; Karamitsos, Theodoros D. ; Neubauer, Stefan. / Myocardial steatosis and left ventricular contractile dysfunction in patients with severe aortic stenosis. In: Circulation: Cardiovascular Imaging. 2013 ; Vol. 6, No. 5. pp. 808-816.
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abstract = "Background-Aortic stenosis (AS) leads to left ventricular (LV) hypertrophy and dysfunction. We hypothesized that cardiac steatosis is involved in the pathophysiology and also assessed whether it is reversible after aortic valve replacement. Methods and Results-Thirty-nine patients with severe AS (symptomatic=25, asymptomatic=14) with normal LV ejection fraction and no significant coronary artery disease and 20 age- and sex-matched healthy controls underwent cardiac 1H-magnetic resonance spectroscopy and imaging for the determination of steatosis (myocardial triglyceride content) and cardiac function, including circumferential strain (measured by magnetic resonance tagging). Strain was lower in both symptomatic and asymptomatic AS (-16.4±2.5{\%} and -18.1±2.9{\%}, respectively, versus controls -20.7±2.0{\%}, both P<0.05). Myocardial steatosis was found in both symptomatic and asymptomatic patients with AS (0.89±0.42{\%} in symptomatic AS; 0.75±0.36{\%} in asymptomatic AS versus controls 0.45±0.17, both P<0.05). Importantly, multivariable analysis indicated that steatosis was an independent correlate of impaired LV strain. Spectroscopic measurements of myocardial triglyceride content correlated significantly with histological analysis of biopsies obtained during aortic valve replacement. At 8.0±2.1 months after aortic valve replacement, steatosis and strain had recovered toward normal. Conclusions-Pronounced myocardial steatosis is present in severe AS, regardless of symptoms, and is independently associated with the degree of LV strain impairment. Myocardial triglyceride content measured by magnetic resonance spectroscopy correlates with histological quantification. Steatosis and strain impairment are reversible after aortic valve replacement. Our findings suggest a novel pathophysiological mechanism in AS, myocardial steatosis, which may be amenable to treatment, thus potentially delaying onset of LV dysfunction.",
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AU - Mahmod, Masliza

AU - Bull, Sacha

AU - Suttie, Joseph J.

AU - Pal, Nikhil

AU - Holloway, Cameron

AU - Dass, Sairia

AU - Myerson, Saul G.

AU - Schneider, Jurgen E.

AU - De Silva, Ravi

AU - Petrou, Mario

AU - Sayeed, Rana

AU - Westaby, Stephen

AU - Clelland, Colin

AU - Francis, Jane M.

AU - Ashrafian, Houman

AU - Karamitsos, Theodoros D.

AU - Neubauer, Stefan

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N2 - Background-Aortic stenosis (AS) leads to left ventricular (LV) hypertrophy and dysfunction. We hypothesized that cardiac steatosis is involved in the pathophysiology and also assessed whether it is reversible after aortic valve replacement. Methods and Results-Thirty-nine patients with severe AS (symptomatic=25, asymptomatic=14) with normal LV ejection fraction and no significant coronary artery disease and 20 age- and sex-matched healthy controls underwent cardiac 1H-magnetic resonance spectroscopy and imaging for the determination of steatosis (myocardial triglyceride content) and cardiac function, including circumferential strain (measured by magnetic resonance tagging). Strain was lower in both symptomatic and asymptomatic AS (-16.4±2.5% and -18.1±2.9%, respectively, versus controls -20.7±2.0%, both P<0.05). Myocardial steatosis was found in both symptomatic and asymptomatic patients with AS (0.89±0.42% in symptomatic AS; 0.75±0.36% in asymptomatic AS versus controls 0.45±0.17, both P<0.05). Importantly, multivariable analysis indicated that steatosis was an independent correlate of impaired LV strain. Spectroscopic measurements of myocardial triglyceride content correlated significantly with histological analysis of biopsies obtained during aortic valve replacement. At 8.0±2.1 months after aortic valve replacement, steatosis and strain had recovered toward normal. Conclusions-Pronounced myocardial steatosis is present in severe AS, regardless of symptoms, and is independently associated with the degree of LV strain impairment. Myocardial triglyceride content measured by magnetic resonance spectroscopy correlates with histological quantification. Steatosis and strain impairment are reversible after aortic valve replacement. Our findings suggest a novel pathophysiological mechanism in AS, myocardial steatosis, which may be amenable to treatment, thus potentially delaying onset of LV dysfunction.

AB - Background-Aortic stenosis (AS) leads to left ventricular (LV) hypertrophy and dysfunction. We hypothesized that cardiac steatosis is involved in the pathophysiology and also assessed whether it is reversible after aortic valve replacement. Methods and Results-Thirty-nine patients with severe AS (symptomatic=25, asymptomatic=14) with normal LV ejection fraction and no significant coronary artery disease and 20 age- and sex-matched healthy controls underwent cardiac 1H-magnetic resonance spectroscopy and imaging for the determination of steatosis (myocardial triglyceride content) and cardiac function, including circumferential strain (measured by magnetic resonance tagging). Strain was lower in both symptomatic and asymptomatic AS (-16.4±2.5% and -18.1±2.9%, respectively, versus controls -20.7±2.0%, both P<0.05). Myocardial steatosis was found in both symptomatic and asymptomatic patients with AS (0.89±0.42% in symptomatic AS; 0.75±0.36% in asymptomatic AS versus controls 0.45±0.17, both P<0.05). Importantly, multivariable analysis indicated that steatosis was an independent correlate of impaired LV strain. Spectroscopic measurements of myocardial triglyceride content correlated significantly with histological analysis of biopsies obtained during aortic valve replacement. At 8.0±2.1 months after aortic valve replacement, steatosis and strain had recovered toward normal. Conclusions-Pronounced myocardial steatosis is present in severe AS, regardless of symptoms, and is independently associated with the degree of LV strain impairment. Myocardial triglyceride content measured by magnetic resonance spectroscopy correlates with histological quantification. Steatosis and strain impairment are reversible after aortic valve replacement. Our findings suggest a novel pathophysiological mechanism in AS, myocardial steatosis, which may be amenable to treatment, thus potentially delaying onset of LV dysfunction.

KW - Aortic valve stenosis

KW - Cardiac MRI

KW - Myocardial steatosis

KW - Spectroscopy

KW - Strain

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