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New perspective on heart valve disease

In aortic valve stenosis, the heart valve is narrowed and the blood can no longer be pumped sufficiently into the body. Patients need a new valve. But the heart muscle also changes due to the disease. Supported by the Central Biobank of the University Medical Center Göttingen (UMG), scientists have discovered that this remodelling of the heart muscle plays a decisive role in the success of the patients' treatment.


Aortic valve stenosis is the most common heart valve disease in older adults. The aortic valve is narrowed and the blood is no longer pumped sufficiently into the body. This often leads to shortness of breath, severe chest pain, dizziness and even unconsciousness.

Functionless connective tissue instead of muscle: "myocardial fibrosis”

In order to stabilise the cardiovascular system in the event of an increased workload, the heart muscle adapts and can undergo pathological changes: The healthy heart tissue is replaced by functionless connective tissue and the muscle hardens. Such "myocardial fibrosis" results in chronic heart weakness. Advanced aortic stenosis should therefore be treated quickly.

New aortic valve via catheter

Transcatheter aortic valve implantation (TAVI) has become the most widely used treatment for aortic stenosis over the past ten years. In this particularly gentle procedure, the calcified aortic valve is pushed aside and a new heart valve is placed in position through the groin artery using a catheter.

Study: Myocardial fibrosis plays an important role in the further course of the disease

Since 2017, doctors at the Heart Center of the University Medical Center Göttingen (UMG) have been investigating the influence of myocardial fibrosis on the remodelling processes of the heart and on the recovery of patients with severe aortic stenosis after TAVI. For this purpose, left ventricular biopsies were taken from 100 patients during the procedure. By analysing the tissue samples, the researchers found that people with more severe myocardial fibrosis had a much higher risk of dying from a cardiovascular cause later in life. The pathological growth of connective tissue slows down the recovery of the heart. Nevertheless, the TAVI procedure itself significantly improved the quality of life of patients with severe fibrosis. The results of the study were published in the renowned European Heart Journal.

Quality-assured biobanking of tissue samples

The Central Biobank of the UMG provided its complete infrastructure for the biobanking of the samples. The staff were responsible for processing the samples and storing them at -80°C and -190°C in liquid nitrogen. "By working with us, the researchers could rely on optimal handling of the study samples," says PD Dr. Sara Y. Nussbeck, Head of the Central Biobank UMG and partner in the German Biobank Alliance (GBA). "With our quality-assured biobanking, we lay the foundation for research findings."

New therapeutic approach

According to the results of the study, the condition of the heart muscle seems to play a much more significant role in survival after valve replacement than previously thought. Aortic stenosis is not only a valve disease, it is also a disease of the left ventricle. "With these results, a new therapeutic approach should be considered to improve long-term survival of patients after TAVI. In the past, we seem to have paid too little attention to the left ventricle after TAVI. So far, there is no concrete treatment for myocardial fibrosis, so anti-fibrotic medications should definitely be tested in future studies," says Prof. Dr. Miriam Puls, managing senior physician of the Department of Cardiology and Pneumology at UMG and first author of the study.


Source: An original version of this text appeared as a press release from the University Medical Center Göttingen (UMG).

Picture credits: University Medical Center Göttingen/Heart Center

Scientific publication

Miriam Puls, Bo Eric Beuthner, Rodi Topci, Anja Vogelgesang, Annalen Bleckmann, Maren Sitte, Torben Lange, Sören Jan Backhaus, Andreas Schuster, Tim Seidler, Ingo Kutschka, Karl Toischer, Elisabeth Zeisberg, Claudius Jacobshagen, Gerd Hasenfuß: Impact of myocardial fibrosis on left ventricular remodelling, recovery, and outcome after transcatheter aortic valve implantation in different haemodynamic subtypes of severe aortic stenosis. European Heart Journal (2020), doi: 10.1093/eurheartj/ehaa033. February 12th, 2020.



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