Postoperative prognostic impact of replacement fibrosis in patients with aortic valve stenosis

Abstract Nowadays, risk assessment in patients undergoing aortic valve replacement (AVR) is mainly performed using Euroscore II risk model. Nevertheless other imaging findings as presence of replacement myocardial fibrosis (RMF) assessed by magnetic resonance imaging (MRI) is reported to be a potent risk marker. Our objective is to assess the prognostic value of RMF in patients undergoing surgical AVR and its value using as reference Euroscore II model. Methods 121 patients without any coronary or additional valve disease undergoing surgical aortic valve replacement were included. All of them have a preoperative MRI study including b-SSFP short axis sequences to assess left ventricular mass, volume and ejection fraction and IR-FGRE sequences to assess replacement fibrosis and also clinical follow up for a median time of 40 months. The postoperative risk of events was also estimated using Euroscore II model. The impact of fibrosis on survival free of cardiovascular events was estimated using the Kaplan-Meier test and its value against reference parameters was estimated using a multivariate Cox model. Results 121 consecutive patients, 50% males with a mean age of 72 years (SD 10) with an average Euroscore value of 1.55 (SD 1) undergoing AVR, 100 (78%) with a biological prosthesis. Patients with replacement fibrosis had significantly decreased survival (p