Late gadolinium enhancement in aortic stenosis: Is it an indication for surgical treatment in asymptomatic patients?

Abstract

Background: It remains a challenge to determine the best time to refer asymptomatic patients for aortic valve replacement (AVR).
Aims: We aimed to determine whether late gadolinium enhancement (LGE) in patients with asymptomatic aortic stenosis (AS) has an independent prognostic significance for adverse postoperative cardiovascular events and changes in left ventricular (LV) hypertrophy (LVH) and LV ejection fraction (LVEF).
Methods: Consecutive patients with severe asymptomatic AS were prospectively enrolled in the study. All patients underwent cardiovascular magnetic resonance with LGE assessment. Patients were followed up every 6 months, and immediately after the onset of symptoms, they were referred for AVR. Early outcomes, as well as LVH and LVEF in the follow-up after AVR, were compared between patients with and without LGE.
Results: Ninety-one patients (34 females, 57 males, median [interquartile range] age: 59.2 [56.9–61.6] years) were evaluated, and 68 persons (75%) were treated with AVR. LGE patients (LGE+) developed symptoms earlier than patients without LGE (LGE–, median [interquartile range]: 18 [7–34] months vs. 28 [14–47] months; P = 0.01), but there were no differences in early complications (P = 0.14) and LVEF (P = 0.47) post-AVR between the groups. One year after AVR, no differences were observed between LGE+ and LGE– patients with regard to LV posterior wall thickness (P = 0.26), interventricular septum thickness (P = 0.16), and LVEF (P = 0.9).
Conclusions: The outcome for patients with asymptomatic AS but with LGE was similar to this observed in the non-LGE group. Watchful waiting in this group, with referral to AVR immediately after symptom onset, is associated with comparable results as in LGE– patients.