ArticleOpen heart2025
High afterload rather than myocardial fibrosis predicts reduced ejection fraction in severe aortic stenosis with afterload mismatch.
Article in Open heart, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Analysis of the Accuracy and Inter-Reader Precision of Scar Quantification Techniques in Aortic Stenosis: A Comparative Cardiovascular Magnetic Resonance Imaging Study.Diagnostics (Basel, Switzerland) · 2026Article
- Article
- First-phase ejection fraction and ventricular-arterial coupling across the lifespan: An in silico analysis.Physiological reports · 2026Article
- Hypertension and Valvular Heart Disease: An Overview of a Complex and Clinically Meaningful Relationship.Life (Basel, Switzerland) · 2026Review
- Transcatheter Aortic Valve Implantation in Cardiogenic Shock: Current Evidence, Clinical Challenges, and Future Directions.Journal of clinical medicine · 2025Review
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Authors and funding
3 authors.
Funding
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Abstract
backgroundAfterload mismatch (AM) refers to high-gradient (mean gradient ≥40 mm Hg) severe aortic stenosis (AS) with reduced left ventricular ejection fraction (LVEF <50%) that is hypothesised to arise from mechanisms other than true contractile impairment. The extent, pattern and functional impact of myocardial fibrosis (MF), which is associated with systolic impairment, is poorly understood in the context of AM.
methodsHigh-gradient severe AS patients with (n=25; low ejection fraction high-gradient, LEF-HG) and without (n=33; normal ejection fraction high-gradient (NEF-HG)) reduced LVEF underwent cardiovascular MRI. Using T1 mapping, extracellular volume (ECV) fraction and late gadolinium enhancement (LGE), the extent and pattern of MF was compared between the two groups. End-systolic wall stress (ESWS) as a measure of afterload was estimated, and its relationship with LVEF was compared with that of MF and LVEF.
resultsStenosis severity was worse in the LEF-HG group (aortic valve area 0.5±0.2 vs 0.7±0.2 cm
conclusionsMF was present in both groups with a higher burden in those with LEF-HG AS. High ESWS, that is, afterload, rather than MF, was the strongest predictor of LVEF. While MF may not directly impact systolic function in AM, it is still an important factor to account for in AS given its association with increased mortality.
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