ArticleOpen heart2026
Distribution of diffuse myocardial fibrosis is uneven and associated with left ventricular function in severe aortic stenosis.
Article in Open heart, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAortic stenosis (AS) leads to left ventricular (LV) remodelling and fibrosis. Myocardial fibrosis can be focal and irreversible, associated with poor prognosis, or diffuse and potentially reversible after surgery. Cardiac magnetic resonance imaging (CMR) shows promise in quantifying diffuse myocardial fibrosis (DMF), but methods vary in precision. The aim of this study was to investigate the presence and distribution of DMF from myocardial biopsies and CMR tissue characteristics in severe AS. Secondarily, explore the association between DMF and LV function.
methodsForty-three patients with severe AS underwent CMR and transthoracic echocardiography within 1 week before surgical aortic valve replacement. CMR included balanced steady-state free-precession cine images, T1 relaxometry with Modified Look-Locker Inversion recovery and extracellular volume calculations. Endomyocardial biopsies were sampled.
resultsHistological analysis of 192 biopsies showed a median LV collagen volume fraction (CVF) of 19%, peaking in segment 1, according to the segment model recommended by the American Heart Association (AHA). There were significant moderate correlations between CVF and extracellular volume in AHA segments 1 (r² = 0.54, p<0.01) and 16 (r² = 0.44, p=0.03), where the DMF had the highest prevalence. Functional assessments demonstrated correlations between CVF and global circumferential and radial strain (r
conclusionCVF varied across LV segments and was significantly highest at the base of the heart, suggesting the start location for fibrosis. Systolic functional data correlated with CVF and T1 relaxation time.
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