Author + information
- Thomas Mark Snow,
- Alistair C. Lindsay,
- Raad Mohiaddin,
- Carlo Di Mario,
- Simon W. Davies,
- Alison Duncan and
- Neil E. Moat
The optimal management of coronary artery disease (CAD) in patients undergoing TAVI for severe symptomatic aortic stenosis is unknown. We use cardiac MRI with late gadolinium enhancement (CMR-LGE) to study the burden of midwall myocardial fibrosis and infarction in this patient population and its relationship to severity of concomitant coronary artery disease.
Single centre, retrospective study of 81 patients with severe symptomatic aortic stenosis treated with TAVI. Pre-procedural CMR-LGE was performed on consecutive patients and interpreted by two independent experienced observers. The presence of infarction and/or myocardial fibrosis was described. Invasive coronary angiography was performed routinely and the coronary artery disease classified by both SYNTAX Score and vessel involvement (0 to 3 vessel disease [VD]).
Sixty-two percent of the population were male, with a mean age of 77.7yrs (±7.4). LVEF≥50% in 49pts (60.5%). Mean SYNTAX Scores for the three CAD groups were significantly different (p=0.01); 1VD 4.1, 2VD 16.6 and 3VD 17. Figure 1illustrates the relationship between increasing severity of CAD (vessel involvement) and infarct/midwall fibrosis burden as demonstrated by CMR-LGE.
Myocardial infarct burden increases with more widespread CAD (p=0.02). Midwall fibrosis, an independent predictor of mortality in patients with moderate to severe aortic stenosis is seen in 33.3 – 45.5% of patients with no or one vessel coronary artery disease.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: New Tests, Targets and Treatments in SIHD
Abstract Category: 10. Chronic CAD/Stable Ischemic Heart Disease: Clinical
Presentation Number: 1240-74
- 2013 American College of Cardiology Foundation