Measurement of myocardial extracellular volume fraction and cardiomyocyte diameter before and 6 months after aortic valve replacement in patients with severe aortic stenosis.

Sharrack, N.; Makins, A.; Biglands, JD.; Kellman, P.; Plein, S.; Buckley, DL.

Measurement of myocardial extracellular volume fraction and cardiomyocyte diameter before and 6 months after aortic valve replacement in patients with severe aortic stenosis.

All Authors

Sharrack, N.

Makins, A.

Biglands, JD.

Kellman, P.

Plein, S.

Buckley, DL.

LTHT Author

Sharrack, Noor
Makins, Alexander
Biglands, John
Plein, Sven

LTHT Department

Cardio-Respiratory
Cardiology
Oncology
Medical Physics & Engineering
NIHR Leeds Biomedical Research Centre

Non Medic

Clinical Scientist
Clinical Scientist

Publication Date

2025

Item Type

Journal Article

Abstract

BACKGROUND: Extra cellular volume fraction (ECV) is an independent predictor of mortality in aortic stenosis (AS). ECV can be measured using myocardial T1 maps acquired before and after contrast administration. Standard ECV measurements do not consider the limited rate of water exchange (WX) between cardiomyocytes and the extracellular matrix which can result in underestimated ECV at higher contrast agent concentrations. OBJECTIVES: The objective was to estimate ECV in patients with severe AS before and after surgical aortic valve replacement (AVR) using a 2-site exchange model (2SXM) that also enables estimates of the intracellular lifetime of water (tauic; an indicator of the minor diameter of the cardiomyocytes). METHODS: 20 patients (67 +/- 6 years) with severe AS, referred for AVR, underwent MRI on a 3T MR system before and 6 months after AVR. T1 measurements were made using a multiparametric saturation-recovery single-shot acquisition before and at multiple time points post-injection of contrast agent. A 2SXM and standard linear model (LM) were used to estimate ECV and, when combined with indexed left ventricular mass (LVMI), to calculate cell and matrix volumes, (LVMI x (1-ECV)/1.05) and (LVMI x ECV/1.05), respectively. The 2SXM model was also used to estimate tauic. RESULTS: Data were acquired before and 174 (157 to 267) days after AVR. LVMI reduced following AVR, from 78 +/- 15g/m2 to 63 +/- 11g/m2 (p<0.001). ECV estimates increased from 22 +/- 3% to 28 +/- 5% (p<0.001) using the LM compared to 28 +/- 5% to 32 +/- 4% (p=0.005) using the 2SXM. Indexed cell volume decreased from 58 +/- 12 cm3/m2 to 43 +/- 9 cm3/m2 (p < 0.001; LM) and from 54 +/- 12 cm3/m2 to 41 +/- 8 cm3/m2 (p<0.001; 2SXM). Indexed matrix volume did not change significantly by either method (LM, 16 +/- 4 cm3/m2 to 17 +/- 3 cm3/m2; 2SXM, 20 +/- 5 cm3/m2 to 19 +/- 3 cm3/m2). tauic decreased from 0.21 +/- 0.12s to 0.12 +/- 0.09s (p=0.007). CONCLUSION: Cellular hypertrophy regressed 6 months following AVR; the extracellular matrix volume did not change significantly. tauic decreased post-AVR indicating that the reduction in cell volume can be largely attributed to a reduction in cardiomyocyte diameter.