The role of fibrosis on the postoperative LV function in severe aortic regurgitation

Introduction In asymptomatic patients with severe aortic regurgitation (AR), the degree of left ventricular (LV) remodelling is a determinant of the postoperative function and survival. The development of LV fibrosis may be assessed by extracellular volume (ECV) determined by cMR-T1 mapping. Objective The aim of the study was to evaluate the impact of the LV fibrosis on the postoperative LV function. Methods Between January 2012 and May 2017, 42 patients (age = 47 ± 13 years, 95% men) with severe AR underwent evaluation of fibrosis by ECV preoperatively and 6 months postoperatively. LV biopsies were performed at the time of surgery and stained with Sirius red. Results The amount of fibrosis quantified by biopsy was 4.95 ± 1.85% [0.97; 8.50], while ECV was 27.46 ± 4.29% [20.67; 37.13] (values are presented as mean ± SD [min; max]). Postoperative ejection fraction was 57% ± 7%. Multivariate regression analysis showed that preoperative EF and histological fibrosis are predictor factors of postoperative EF. Conclusion LV fibrosis is a major predictor of postoperative LV EF. It may be assessed by ECV and help to determine the right time for surgery in asymptomatic patients with severe AR.