Coronary Artery Disease Assessed by Computed Tomography-Based Leaman Score in Patients With Low-Risk Transcatheter Aortic Valve Implantation - 26/03/20

Doi : 10.1016/j.amjcard.2020.01.022

Yuichi Ozaki, MD, PhD ^a, Hector M. Garcia-Garcia, MD, PhD ^a,^⁎ , Toby Rogers, MD, PhD ^a,^b, Rebecca Torguson, MPH ^a, Paige E. Craig, MPH ^a, Alexandre Hideo-Kajita, MD ^a, Paul Gordon, MD ^c, Afshin Ehsan, MD ^d, Puja Parikh, MD ^e, Thomas Bilfinger, MD, ScD ^f, David Butzel, MD ^g, Scott Buchanan, MD ^g, Robert Levitt, MD ^h, Chiwon Hahn, MD ⁱ, Maurice Buchbinder, MD ^j, Nicholas Hanna, MD ^k, Robert Garrett, MD ^l, Sean R. Wilson, MD ^m, John A. Goncalves, MD ⁿ, Syed Ali, MBBS ^a, Federico M. Asch, MD ^o, Gaby Weissman, MD ^p, Christian Shults, MD ^q, Itsik Ben-Dor, MD ^a, Lowell F. Satler, MD ^a, Ron Waksman, MD ^a
^a Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
^b Cardiovascular Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
^c Division of Cardiology, Miriam Hospital, Providence, Rhode Island
^d Division of Cardiothoracic Surgery, Lifespan Cardiovascular Institute, Providence, Rhode Island
^e Department of Medicine, Stony Brook Hospital, Stony Brook, New York
^f Department of Surgery, Stony Brook Hospital, Stony Brook, New York
^g Cardiovascular Service Line, Maine Medical Center, Portland, Maine
^h Department of Cardiology, Henrico Doctors’ Hospital, Richmond, Virginia
ⁱ Department of Cardiothoracic Surgery, Henrico Doctors’ Hospital, Richmond, Virginia
^j Foundation for Cardiovascular Medicine, Stanford University, Stanford, California
^k St. John Heart Institute Cardiovascular Consultants, St. John Health System, Tulsa, Oklahoma
^l St. John Clinic Cardiovascular Surgery, St. John Heart Institute Cardiovascular Consultants, St. John Health System, Tulsa, Oklahoma
^m Department of Medicine, Valley Hospital, Ridgewood, New Jersey
ⁿ Cardiac Surgery Program, Valley Hospital, Ridgewood, New Jersey
^o MedStar Health Research Institute, MedStar Washington Hospital Center, Washington, District of Columbia
^p Department of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
^q Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, District of Columbia

^⁎Corresponding author: Tel: (202) 877-2812; fax: (202) 877-2715

Résumé

We aimed to evaluate the burden of coronary artery disease (CAD) using the computed tomography (CT) Leaman score in low-risk transcatheter aortic valve implantation (TAVI) patients. The extent of CAD in low-risk patients with aortic stenosis who are candidates for TAVI has not been accurately quantified. The CT Leaman score was developed to quantify coronary CT angiography (CCTA) atherosclerotic burden and has been validated to evaluate the extent of CAD. CT Leaman score >5 has been associated with an increase in major adverse cardiac events over long-term follow-up. The study population included patients enrolled in the Low Risk TAVI trial who underwent CCTA before the procedure. For the CT Leaman score, we used 3 sets of weighting factors: (1) location of coronary plaques, (2) type of plaque, and (3) degree of stenosis. A total of 200 patients were enrolled in the Low Risk TAVI trial. Excluded were 31 patients who had no analyzable CCTA imaging. For the remaining 169 patients, the mean CT Leaman score was 6.27 ± 0.27, of whom 102 (60.4%) had CT Leaman score >5. Nearly all analyzed patients (97%) had coronary plaques. Furthermore, 33 patients (19.5%) had potentially obstructive coronary plaques (>50% stenosis by CCTA) in proximal segments. Most low-risk TAVI patients have significant CAD burden by CCTA. It should be a priority for future TAVI devices to guarantee unimpeded access to the coronary arteries for selective angiography and interventions.

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Funding: The Low Risk TAVI (LRT) trial, NCT02628899, was funded by MedStar Health Research Institute, Washington, DC.

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Vol 125 - N° 8

P. 1216-1221 - avril 2020 Retour au numéro

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Coronary Artery Disease Assessed by Computed Tomography-Based Leaman Score in Patients With Low-Risk Transcatheter Aortic Valve Implantation - 26/03/20

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