부산대학교 도서관

Background: Severe aortic stenosis (AS), leads to pathological left ventricular remodeling that may worsen with concomitantoverweight and obesity (OW/O). Methods: We aimed to prospectively analyze the impact of OW/O on ventricular remodeling in severe AS, by evaluating thepercentage of intraendomyocardial fibrosis (PIEF) and the percentage of infiltrating intraendocardial lipid vacuoles (PIELV) andits relationship to global longitudinal strain (GLS) in patients with OW/O. Results: 44 patients with severe AS were included, 13 non-obese (29%) and 31 OW/O (71%), all of them with left ventricularejection fraction ≥ 55%. GLS was evaluated with 2D speckle tracking. During valve replacement, an endocardial biopsy wasobtained, where PIEF and PIELV were analyzed. Patients with higher PIEF and PIELV had greater body mass index (p < 0.0001)and worse GLS (p < 0.0053). A GLS cut-off point < -14% had a sensitivity of 75%, and a specificity of 92.8% to detect importantPIEF (AUC: 0.928, 95% confidence interval: 0.798–1.00). On multivariate analysis, OW/O and PIELV were independentlyassociated to the PIEF, and OW/O and PIEF were independently associated to GLS. A high correlation between the amount ofPIELV and PIEF were found. Conclusion: Patients with severe AS and OW/O have greater PIEF and PIELV, suggesting more pathological remodeling. GLS is useful to detect subclinical myocardial injury and is potentially useful for endomyocardial fibrosis detection. The presenceof higher PIELF may be a trigger factor for the development of intraendomyocardial fibrosis.