Aortic Stenosis, Left Ventricular Hypertrophy, Myocardial Fibrosis
Conditions
Keywords
Troponin
Brief summary
Aortic stenosis is the most common heart valve disease requiring intervention in high income countries. It is characterised by progressive valvular thickening, and restriction as well is hypertrophy and fibrosis of the left ventricle in response to pressure overload. The pathological processes in the left ventricle that ultimately result in heart failure and death are incompletely understood. Further elucidation of these processes and how they correlate with novel blood biomarkers may help us design new treatments and optimise the timing of surgical intervention. In brief, recruited patients with severe aortic stenosis and scheduled to undergo valve replacement surgery will be invited for some simple tests (blood sampling, ECG, echocardiogram). A septal myocardial biopsy will be taken at the time of surgery and the disease valve retained. These will be examined histologically and pathological changes compared with results obtained from ECG, echocardiogram and blood tests.
Interventions
None listed
Sponsors
University of Edinburgh
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Inclusion Criteria (aortic stenosis group): * Age over 18 * Severe aortic stenosis with planned aortic valve replacement Inclusion Criteria (control group): * Age over 18 * Planned non-aortic valve cardiac or elective ascending aorta surgery
Exclusion criteria
(aortic stenosis group): * Coexistent severe aortic or mitral regurgitation * Coexistent mitral stenosis greater than mild in severity * Acute valvular heart disease (e.g. acute mitral regurgitation or endocarditis) * Acute pulmonary oedema or cardiogenic shock * Coexistent hypertrophic cardiomyopathy * Unable to give informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Correlation of blood biomarkers with pathological changes on myocardial biopsy | Biomarkers collected within 1 month prior to date of surgery (and myocardial biopsy) | Correlation between biomarkers (e.g. high sensitivity troponin I, BNP) with levels of myocardial fibrosis (collagen volume fraction as measured by picrosirius red staining) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Correlation of echocardiographic and ECG measures with pathological changes on myocardial biopsy | Biomarkers collected within 1 month prior to date of surgery (and myocardial biopsy) | Correlation between imaging measures (e.g. LV diastolic function, longitudinal systolic function, ECG LVH criteria, ECG strain pattern) with levels of myocardial fibrosis (collagen volume fraction as measured by picrosirius red staining) |
Countries
United Kingdom
Outcome results
None listed