Project Title

Timing of aortic valve replacement in severe aortic valve stenosis: T1 mapping as a potential marker

Background

Timing of aortic valve replacement (AVR) in severe asymptomatic aortic stenosis (AS) is controversial and a balance of risks and benefits. We believe that diffuse myocardial fibrosis, a key driver of heart failure in AS, could be an early marker of reversible left ventricular decompensation in asymptomatic AS patients. T1 mapping by cardiac magnetic resonance is a novel technique to quantify myocardial fibrosis. Determining a cut-off value by T1 mapping might ultimately aid to correctly identify asymptomatic patients who would benefit from surgery.

Aim

We will investigate T1 mapping as a potential marker for the timing of AVR in severe AS. We expect that myocardial fibrosis will regress in asymptomatic patients undergoing AVR compared with (a) symptomatic patients undergoing AVR, and (b) asymptomatic patients randomized to watchful waiting. In such case, asymptomatic patients might benefit from earlier surgery than currently recommended in guidelines.

Methods

This is a 1-year follow-up study of patients with severe AS. We will compare symptomatic and asymptomatic patients with regards to the change in myocardial fibrosis with T1 mapping before and after AVR. T1 mapping will be performed at baseline and at 1-year follow-up.

Participants:

• ≥ 30 patients with severe symptomatic AS undergoing AVR according to current guidelines
• ≥ 60 patients with severe asymptomatic AS randomized 1:1 to either watchful waiting or “early” AVR
• ≥ 90 healthy controls matched 1:1