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

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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.

Section snippets

Methods

A detailed description of the study has been previously published.8 In brief, the LRT trial was a prospective, multicenter, feasibility trial conducted between February 16, 2016, and February 8, 2018, to test the safety of transfemoral TAVI in low-risk patients with symptomatic, severe AS who were confirmed to be low risk based on a Society of Thoracic Surgeons – Predicted Risk of Mortality score ≤3% and absence of co-morbidities.9 Severe AS was defined as a mean aortic valve gradient ≥40 mm Hg

Results

A total of 200 patients were enrolled in the LRT trial. We excluded patients who had no analyzable CCTA imaging (n = 31). The remaining 169 patients were included in this study. Baseline characteristics are summarized in Table 1. Of these, 102 (60.4%) patients had CT Leaman score >5 (Figure 1). Potentially obstructive coronary plaques (>50% stenosis by CCTA) were observed in 44 patients with CT Leaman score >5 and 3 patients with CT Leaman score ≤5. The mean CT Leaman score of all patients was

Discussion

The main finding of this LRT trial subanalysis is that low-risk TAVI patients have a significant burden of CAD as evidenced by the mean CT Leaman score of 6.27 ± 0.27. Furthermore, 102 patients (60.4%) had a CT Leaman score >5, and 33 patients (19.5%) had potentially obstructive coronary plaques (>50% stenosis by CCTA) in proximal segments.

In the FRANCE-2 French national TAVI registry, which includes all consecutive TAVI performed between January 2010 and January 2012 in 34 centers, the

Disclosures

Toby Rogers – Consultant & Proctor: Medtronic, Edwards Lifesciences.

Gaby Weissman – Director of an academic cardiovascular imaging core lab with institutional contracts with Boston Scientific, Ancora Heart. LivaNova, and HDL Therapeutics.

John Goncalves – Proctor: Medtronic.

Nicholas Hanna – Speaker: Edwards.

Federico M. Asch – Director of an academic cardiovascular imaging core lab with institutional contracts with Edwards, Medtronic, Boston Scientific, Biotronik, and Abbott.

Ron Waksman –

Author Contribution

The authors contributed to this work as shown below:

Yuichi Ozaki: conception and design, analysis and interpretation of data, drafting of the manuscript, revising it critically for important intellectual content, final approval of the manuscript submitted.

Hector M. Garcia-Garcia: conception and design, analysis and interpretation of data, revising it critically for important intellectual content, final approval of the manuscript submitted.

Toby Rogers: revising it critically for important

References (20)

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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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