Myocardial Fibrosis Extent and Pattern Associated With Outcomes in Aortic Regurgitation

An observational study in European Heart Journal – Cardiovascular Imaging examined whether replacement myocardial fibrosis characteristics were associated with outcomes in chronic aortic regurgitation. Investigators included 363 consecutive patients with moderate-to-severe regurgitation and no significant coronary artery stenosis who underwent contrast-enhanced cardiac magnetic resonance imaging between 2010 and 2024. Mean age was 52.6 years, and 54 patients were female. The primary endpoint was major adverse cardiovascular events (MACE): cardiovascular mortality, heart transplantation, or rehospitalization for heart failure.

Over a median 56.6 months, 73 patients experienced MACE. Late gadolinium enhancement (LGE) was present in 200 patients (55.1%). An LGE extent threshold of 2.6% provided the best reported risk stratification, with a C-index of 0.797. A predominant subendocardial-involved pattern occurred in 13.5% of LGE-positive patients and was independently associated with MACE after adjustment for LGE extent (hazard ratio 3.028; 95% CI 1.216–7.539). Patients with both LGE extent above 2.6% and this pattern had the highest risk in Kaplan–Meier analysis.

These findings suggest that fibrosis extent and pattern may refine prognostic assessment beyond LGE presence alone. However, the observational associations do not establish whether imaging-guided treatment improves outcomes. Only the abstract was available; external validation of the threshold and the full adjustment strategy could not be assessed.