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OBJECTIVES: Cardiac magnetic resonance (CMR) was used to investigate the extracellular compartment and myocardial fibrosis in patients with aortic stenosis, as well as their association with other measures of left ventricular decompensation and mortality. BACKGROUND: Progressive myocardial fibrosis drives the transition from hypertrophy to heart failure in aortic stenosis. Diffuse fibrosis is associated with extracellular volume expansion that is detectable by T1 mapping, whereas late gadolinium enhancement (LGE) detects replacement fibrosis. METHODS: In a prospective observational cohort study, 203 subjects (166 with aortic stenosis [69 years; 69% male]; 37 healthy volunteers [68 years; 65% male]) underwent comprehensive phenotypic characterization with clinical imaging and biomarker evaluation. On CMR, we quantified the total extracellular volume of the myocardium indexed to body surface area (iECV). The iECV upper limit of normal from the control group (22.5 ml/m2) was used to define extracellular compartment expansion. Areas of replacement mid-wall LGE were also identified. All-cause mortality was determined during 2.9 ± 0.8 years of follow up. RESULTS: iECV demonstrated a good correlation with diffuse histological fibrosis on myocardial biopsies (r = 0.87; p 

Original publication




Journal article


Jacc cardiovasc imaging

Publication Date





1320 - 1333


T1 mapping, aortic stenosis, fibrosis, hypertrophy, magnetic resonance imaging, myocardium, Aged, Aortic Valve Stenosis, Biopsy, Cardiomyopathies, Case-Control Studies, Disease Progression, Echocardiography, Female, Fibrosis, Heart Failure, Humans, Hypertrophy, Left Ventricular, Kaplan-Meier Estimate, Magnetic Resonance Imaging, Male, Middle Aged, Myocardium, Prospective Studies, Risk Factors, Time Factors, Ventricular Function, Left, Ventricular Remodeling