Роль магнитно-резонансной томографии у пациентов с аортальным стенозом до и после замены клапана - Журнал Терапевтический архив №9 Вопросы кардиологии 2020

Роль магнитно-резонансной томографии у пациентов с аортальным стенозом до и после замены клапана

Шария М.А., Устюжанин Д.В., Лепилин П.М. и др. Роль магнитно-резонансной томографии у пациентов с аортальным стенозом до и после замены клапана. Терапевтический архив. 2020; 92 (9): 70–76.
DOI: 10.26442/00403660.2020.09.000657

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Shariya M.A., Ustyuzhanin D.V., Lepilin P.M., et al. Role of magnetic resonance imaging in patients with aortic stenosis before and after replacement of the valve. Therapeutic Archive. 2020; 92 (9): 70–76 . DOI: 10.26442/00403660.2020.09.000657

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Аннотация

Стратификация риска среди пациентов с аортальным стенозом остается неадекватной, и имеется клиническая необходимость в корректной идентификации пациентов высокого риска, которым стало бы полезно вмешательство на аортальном клапане до развития декомпенсации левого желудочка. С момента публикации результатов исследования PARTNER транскатетерная имплантация аортального клапана (transcatheter aortic valve implantation – TAVI) стала методом выбора при стенозе аортального клапана у неоперабельных пациентов и является реальной альтернативой обычной хирургической замене аортального клапана у пациентов высокого риска. При планировании TAVI и постоперационном наблюдении за пациентом из методов визуализации ведущая роль отводится эхокардиографии и мультиспиральной компьютерной томографии. Однако за последнее время возрос интерес исследователей к применению магнитно-резонансной томографии у данной категории пациентов. В обзорной статье рассматривается потенциальная роль применения магнитно-резонансной томографии у пациентов с аортальным стенозом до и после проведения TAVI.

Ключевые слова: аортальный стеноз, транскатетерная имплантация аортального клапана, сердечно-сосудистая магнитно-резонансная томография.

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Risk stratification among patients with aortic stenosis remains inadequate, and there is a clinical need for the correct identification of high-risk patients who would benefit from aortic valve intervention before developing left ventricular decompensation. Since the publication of the results of the PARTNER study, transcatheter aortic valve implantation (TAVI) has become the method of choice for aortic valve stenosis in inoperable patients and is a real alternative to conventional surgical replacement of the aortic valve in high-risk patients. In planning TAVI and postoperative monitoring of a patient from imaging methods, the leading role is played by echocardiography and multispiral computed tomography. However, in recent years, the interest of researchers in the use of magnetic resonance imaging in this category of patients has increased. The review article examines the potential role of magnetic resonance imaging in patients with aortic stenosis before and after TAVI.

Keywords: aortic stenosis, transcatheter aortic valve implantation, cardiovascular magnetic resonance imaging.

Список литературы

1. Nkomo VT, Gardin JM, Skelton TN, et al. Burden of valvular heart diseases: a population-based study. Lancet. 2006;368(9540):1005-11. doi: 10.1016/S0140-6736(06)69208-8
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13. Weidemann F, Herrmann S, Stork S, et al. Impact of myocardial fibrosis in patients with symptomatic severe aortic stenosis. Circulation. 2009;120:577-84. doi: 10.1161/CIRCULATIONAHA.108.847772
14. Dobson J, Whitley RJ, Pocock S, Monto AS. Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trials. Lancet. 2015;385(9979):1729-37. doi: 10.1016/S0140-6736(14)62449-1
15. Mewton N, Liu CY, Croisille P, et al. Assessment of myocardial fibrosis with cardiovascular magnetic resonance. J Am Coll Cardiol. 2011;57:891-903. doi: 10.1016/j.jacc.2010.11.013
16. Azevedo CF, Nigri M, Higuchi ML, et al. Prognostic significance of myocardial fibrosis quantification by histopathology and magnetic resonance imaging in patients with severe aortic valve disease. J Am Coll Cardiol. 2010;56(4):278-87. doi: 10.1016/j.jacc.2009.12.074
17. Balciunaite G, Skorniakov V, Rimkus A, et al. Prevalence and prognostic value of late gadolinium enhancement on CMR in aortic stenosis: meta-analysis. Eur Radiol. 2020;30(1):640-51. doi: 10.1016/ j.crad.2018.07.095
18. Fairbairn T, et al. The effect of myocardial fibrosis on ventricular remodeling following valve replacement for severe aortic stenosis. A CMR study comparing transcatheter aortic valve implantation and surgical aortic valve replacement. J Cardiovasc Magnetic Resonance. 2012;14(Suppl. 1):O71. doi: 10.1186/1532-429X-14-S1-O71
19. Otto CM. Valvular aortic stenosis: disease severity and timing of intervention. J Am Coll Cardiol. 2006;47:2141-51. doi: 10.1016/j.jacc.2006.03.002
20. Barone-Rochette G, Pierard S, De Meester de Ravenstein C, et al. Prognostic significance of LGE by CMR in aortic stenosis patients undergoing valve replacement. J Am Coll Cardiol. 2014:64(2):144-54. doi: 10.1016/j.jacc.2014.02.612
21. Bing R, Dweck MR. Myocardial Fibrosis in Low-Flow Aortic Stenosis. Circ Cardiovasc Imaging. 2019;12(5):e009187. doi: 10.1161/CIRCIMAGING.119.009187
22. Grotenhuis HB, Ottenkamp J, Westenberg JJ, et al. Reduced aortic elasticity and dilatation are associated with aortic regurgitation and left ventricular hypertrophy in nonstenotic bicuspid aortic valve patients.
J Am Coll Cardiol. 2007;49(15):1660-5. doi: 10.1016/j.jacc.2006.12.044
23. Steadman CD, Jerosch-Herold M, Grundy B, et al. Determinants and functional significance of myocardial perfusion reserve in severe aortic stenosis. JACC Cardiovasc Imaging. 2012;5(2):182-9. doi: 10.1016/j.jcmg.2011.09.022
24. Kim WK, Rolf A, Liebetrau C, et al. Detection of myocardial injury by CMR after transcatheter aortic valve replacement. J Am Coll Cardiol. 2014;64:349-57. doi: 10.1016/j.jacc.2014.03.052
25. Fairbairn TA, Steadman CD, Mather AN, et al. Assessment of valve haemodynamics, reverse ventricular remodelling and myocardial fibrosis following transcatheter aortic valve implantation compared to surgical aortic valve replacement: a cardiovascular magnetic resonance study. Heart. 2013;99(16):1185-91. doi: 10.1136/heartjnl-2013-303927
26. Crouch G, Bennetts J, Sinhal A, et al. Early effects of transcatheter aortic valve implantation and aortic valve replacement on myocardial function and aortic valve hemodynamics: insights from cardiovascular magnetic resonance imaging. J Thorac Cardiovasc Surg. 2015;149(2):462-70. doi: 10.1016/j.jtcvs
27. Kodali WS, Pibarot P, Williams M, et al. Paravalvular regurgitation after transcatheter aortic valve replacement with the Edwards sapien valve in the PARTNER trial: characterizing patients and impact on outcomes. Eur Heart J. 2015;36(7):449-56. doi: 10.1093/eurheartj/ehu384
28. Crouch G, Tully P, Bennetts J, et al. Quantitative assessment of paravalvular regurgitation following transcatheter aortic valve replacement.
J Cardiovasc Magn Reson. 2015;17:32. doi: 10.1186/s12968-015-0134-0
29. Musa TA, Plein S, Greenwood JP. The role of CMR in the assessment of severe aortic stenosis and in post-procedural evaluation following TAVI and surgical AVR. Quant Imaging Med Surg. 2016;6(3):259-73. doi: 10.21037/qims.2016.06.05
30. Mahmod M, Bull S, Suttie JJ, et al. Myocardial steatosis and left ventricular contractile dysfunction in patients with severe aortic stenosis. Circ Cardiovasc Imaging. 2013;6(5):808-16. doi: 10.1161/CIRCIMAGING.113.000559
31. Meyer CG, Frick M, Lotfi S, et al. Regional left ventricular function after transapical vs. transfemoral transcatheter aortic valve implantation analysed by cardiac magnetic resonance feature tracking. Eur Heart J Cardiovasc Imaging. 2014;15(10):1168-76. doi: 10.1093/ehjci/jeu103
32. Kearney LG, Lu K, Ord M, et al. Global longitudinal strain is a strong independent predictor of all-cause mortality in patients with aortic stenosis. Eur Heart J Cardiovasc Imaging. 2012;13(10):827-33. doi: 10.1093/ehjci/jes115
33. Yingchoncharoen T, Gibby C, Rodriguez LL, et al. Association of myocardial deformation with outcome in asymptomatic aortic stenosis with normal ejection fraction. Circ Cardiovasc Imaging. 2012;5(6):719-25. doi: 10.1161/CIRCIMAGING.112.977348
34. Von Knobelsdorff-Brenkenhoff F, Trauzeddel RF, Barker AJ, et al. Blood flow characteristics in the ascending aorta after aortic valve replacement – a pilot study using 4D-flow MRI. Int J Cardiol. 2014;170(3):426-33. doi: 10.1016/j.ijcard.2013.11.034

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1. Nkomo VT, Gardin JM, Skelton TN, et al. Burden of valvular heart diseases: a population-based study. Lancet. 2006;368(9540):1005-11. doi: 10.1016/S0140-6736(06)69208-8
2. Eveborn GW, Schirmer H, Heggelund G, et al. The evolving epidemiology of valvular aortic stenosis. the Tromso study. Heart. 2013;99(6):396-400. doi: 10.1136/heartjnl-2012-302265
3. Vahanian A, Otto CM. Risk stratification of patients with aortic stenosis. Eur Heart J. 2010;31(4):416-23. doi: 10.1093/eurheartj/ehp575
4. Uddin A, Fairbairn TA, Djoukhader IK, et al. Consequence of cerebral embolism after transcatheter aortic valve implantation compared with contemporary surgical aortic valve replacement: effect on health-related quality of life. Circ Cardiovasc Interv. 2015;8(3):e001913. doi: 10.1161/circinterventions.114.001913
5. Mahon C, Mohiaddin RH, The emerging applications of cardiovascular magnetic resonance imaging in transcatheter aortic valve implantation. Clin Radiol. 2019. pii: S0009-9260(19)30656-7. doi: 10.1016/j.crad.2019.11.011
6. Baumgartner H, Falk V, Bax JJ, Group ESCSD, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017;38:2739-91. doi: 10.1093/eurheartj/ehx391
7. Kusunose K, Goodman A, Parikh R, et al. Incremental prognostic value of left ventricular global longitudinal strain in patients with aortic stenosis and preserved ejection fraction. Circ Cardiovasc Imaging. 2014;7(6):938-45. doi: 10.1161/CIRCIMAGING.114.002041
8. Ternovoy SK, Nikonova ME, Veselova TN, et al. Multislice computed tomography in planning of transcatheter aortic valve implantation. REJR. 2013:3(1):43-9 (In Russ.)
9. Childs H, Ma L, Ma M, et al. Comparison of long and short axis quantification of left ventricular volume parameters by cardiovascular magnetic resonance, with ex-vivo validation. J Cardiovasc Magn Reson. 2011;13:40. doi: 10.1186/1532-429X-13-40
10. Терновой С.К. Томография сердца. М., 2018 [Ternovoy SK. Heart tomography. Moscow, 2018 (In Russ.)].
11. Ambale-Venkatesh B, Lima JA. Cardiac MRI: a central prognostic tool in myocardial fibrosis. Nat Rev Cardiol. 2015;12(1):18-29. doi: 10.1038/nrcardio.2014.159
12. Milano AD, Faggian G, Dodonov M, et al. Prognostic value of myocardial fibrosis in patients with severe aortic valve stenosis. J Thorac Cardiovasc Surg. 2012;144(4):830-7. doi: 10.1016/j.jtcvs.2011.11.024
13. Weidemann F, Herrmann S, Stork S, et al. Impact of myocardial fibrosis in patients with symptomatic severe aortic stenosis. Circulation. 2009;120:577-84. doi: 10.1161/CIRCULATIONAHA.108.847772
14. Dobson J, Whitley RJ, Pocock S, Monto AS. Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trials. Lancet. 2015;385(9979):1729-37. doi: 10.1016/S0140-6736(14)62449-1
15. Mewton N, Liu CY, Croisille P, et al. Assessment of myocardial fibrosis with cardiovascular magnetic resonance. J Am Coll Cardiol. 2011;57:891-903. doi: 10.1016/j.jacc.2010.11.013
16. Azevedo CF, Nigri M, Higuchi ML, et al. Prognostic significance of myocardial fibrosis quantification by histopathology and magnetic resonance imaging in patients with severe aortic valve disease. J Am Coll Cardiol. 2010;56(4):278-87. doi: 10.1016/j.jacc.2009.12.074
17. Balciunaite G, Skorniakov V, Rimkus A, et al. Prevalence and prognostic value of late gadolinium enhancement on CMR in aortic stenosis: meta-analysis. Eur Radiol. 2020;30(1):640-51. doi: 10.1016/ j.crad.2018.07.095
18. Fairbairn T, et al. The effect of myocardial fibrosis on ventricular remodeling following valve replacement for severe aortic stenosis. A CMR study comparing transcatheter aortic valve implantation and surgical aortic valve replacement. J Cardiovasc Magnetic Resonance. 2012;14(Suppl. 1):O71. doi: 10.1186/1532-429X-14-S1-O71
19. Otto CM. Valvular aortic stenosis: disease severity and timing of intervention. J Am Coll Cardiol. 2006;47:2141-51. doi: 10.1016/j.jacc.2006.03.002
20. Barone-Rochette G, Pierard S, De Meester de Ravenstein C, et al. Prognostic significance of LGE by CMR in aortic stenosis patients undergoing valve replacement. J Am Coll Cardiol. 2014:64(2):144-54. doi: 10.1016/j.jacc.2014.02.612
21. Bing R, Dweck MR. Myocardial Fibrosis in Low-Flow Aortic Stenosis. Circ Cardiovasc Imaging. 2019;12(5):e009187. doi: 10.1161/CIRCIMAGING.119.009187
22. Grotenhuis HB, Ottenkamp J, Westenberg JJ, et al. Reduced aortic elasticity and dilatation are associated with aortic regurgitation and left ventricular hypertrophy in nonstenotic bicuspid aortic valve patients.
J Am Coll Cardiol. 2007;49(15):1660-5. doi: 10.1016/j.jacc.2006.12.044
23. Steadman CD, Jerosch-Herold M, Grundy B, et al. Determinants and functional significance of myocardial perfusion reserve in severe aortic stenosis. JACC Cardiovasc Imaging. 2012;5(2):182-9. doi: 10.1016/j.jcmg.2011.09.022
24. Kim WK, Rolf A, Liebetrau C, et al. Detection of myocardial injury by CMR after transcatheter aortic valve replacement. J Am Coll Cardiol. 2014;64:349-57. doi: 10.1016/j.jacc.2014.03.052
25. Fairbairn TA, Steadman CD, Mather AN, et al. Assessment of valve haemodynamics, reverse ventricular remodelling and myocardial fibrosis following transcatheter aortic valve implantation compared to surgical aortic valve replacement: a cardiovascular magnetic resonance study. Heart. 2013;99(16):1185-91. doi: 10.1136/heartjnl-2013-303927
26. Crouch G, Bennetts J, Sinhal A, et al. Early effects of transcatheter aortic valve implantation and aortic valve replacement on myocardial function and aortic valve hemodynamics: insights from cardiovascular magnetic resonance imaging. J Thorac Cardiovasc Surg. 2015;149(2):462-70. doi: 10.1016/j.jtcvs
27. Kodali WS, Pibarot P, Williams M, et al. Paravalvular regurgitation after transcatheter aortic valve replacement with the Edwards sapien valve in the PARTNER trial: characterizing patients and impact on outcomes. Eur Heart J. 2015;36(7):449-56. doi: 10.1093/eurheartj/ehu384
28. Crouch G, Tully P, Bennetts J, et al. Quantitative assessment of paravalvular regurgitation following transcatheter aortic valve replacement.
J Cardiovasc Magn Reson. 2015;17:32. doi: 10.1186/s12968-015-0134-0
29. Musa TA, Plein S, Greenwood JP. The role of CMR in the assessment of severe aortic stenosis and in post-procedural evaluation following TAVI and surgical AVR. Quant Imaging Med Surg. 2016;6(3):259-73. doi: 10.21037/qims.2016.06.05
30. Mahmod M, Bull S, Suttie JJ, et al. Myocardial steatosis and left ventricular contractile dysfunction in patients with severe aortic stenosis. Circ Cardiovasc Imaging. 2013;6(5):808-16. doi: 10.1161/CIRCIMAGING.113.000559
31. Meyer CG, Frick M, Lotfi S, et al. Regional left ventricular function after transapical vs. transfemoral transcatheter aortic valve implantation analysed by cardiac magnetic resonance feature tracking. Eur Heart J Cardiovasc Imaging. 2014;15(10):1168-76. doi: 10.1093/ehjci/jeu103
32. Kearney LG, Lu K, Ord M, et al. Global longitudinal strain is a strong independent predictor of all-cause mortality in patients with aortic stenosis. Eur Heart J Cardiovasc Imaging. 2012;13(10):827-33. doi: 10.1093/ehjci/jes115
33. Yingchoncharoen T, Gibby C, Rodriguez LL, et al. Association of myocardial deformation with outcome in asymptomatic aortic stenosis with normal ejection fraction. Circ Cardiovasc Imaging. 2012;5(6):719-25. doi: 10.1161/CIRCIMAGING.112.977348
34. Von Knobelsdorff-Brenkenhoff F, Trauzeddel RF, Barker AJ, et al. Blood flow characteristics in the ascending aorta after aortic valve replacement – a pilot study using 4D-flow MRI. Int J Cardiol. 2014;170(3):426-33. doi: 10.1016/j.ijcard.2013.11.034

Авторы

М.А. Шария1, Д.В. Устюжанин1, П.М. Лепилин1, Т.Э. Имаев1, А.Е. Комлев1, А.А. Беляевская1, С.К. Терновой1,2

1 Институт клинической кардиологии им. А.Л. Мясникова ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия;
2 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия

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M.A. Shariya1, D.V. Ustyuzhanin1, P.M. Lepilin1, T.E. Imaev1, A.E. Komlev1, A.A. Belyaevskaya1, S.K. Ternovoy1,2

1 Myasnikov Institute of Clinical Cardiology, National Medical Research Center for Cardiology, Moscow, Russia;
2 Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia

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