Abstract 2261: How Useful is Screening Cardiovascular MRI for Detecting Aortic Complications in Patients With Repaired Coarctation of the Aorta?
Background: Pts with repaired coarctation of the aorta (rCOA) are at risk for late aortic complications (AoC), including recoarctation (ReC) and aneurysm (AoAn), which contribute to a higher than expected incidence of sudden cardiac death. Guidelines recommend screening cardiovascular MRI (Sc-CMR), although data to support this approach and its utility in clinical practice is limited. Therefore, we sought to determine if Sc-CMR detects AoC, and to characterize pts at risk for AoC who may benefit from increased CMR surveillance.
Methods: We reviewed CMR on pts ≥13 yrs with rCOA. Demographics, blood pressure, symptoms, and echocardiogram (TTE) findings prior to CMR were recorded. Aortic diameters were measured at multiple locations by 3-D CMR and indexed to aorta at the diaphragm (DDAo). ReC was defined as isthmus/DDAo ≤0.5 (at risk≤0.75), and AoAn as max diameter/DDAo ≥1.5 (at risk≥1.25). Pts with clinical abnormalities (Sx-CMR) were compared to asymptomatic pts (Sc-CMR) using chi-square and T-test. Logistic regression was used to predict risk of AoC.
Results: From 1/03–12/08, 76 pts met inclusion criteria. Mean age at CMR was 30.6 ± 10.5 yrs. Sx-CMR was performed in 40 pts and Sc-CMR in 36 pts. There were no differences in age or type of surgical repair. No pt met criteria for ReC (at risk 10/40 Sx-CMR vs 5/36 Sc-CMR, p=NS). Women (OR 3.4) and pts with heart failure symptoms (OR 6.9) were more likely to have at risk ReC (p<0.05). Hypertension (OR 1.6), angina (OR 1.8), and ReC by TTE (OR 2.7) were also predictive, although p=NS. AoAn was found in 15% of Sx-CMR and 11% of Sc-CMR (at risk 8/40 vs 7/36), p=NS. No factors predicted the development of AoAn, including surgical repair and TTE. Overall, 12 pts underwent subsequent transcatheter stent placement (n=6) or AoAn repair (n=6). Four pts (11%) were referred after Sc-CMR. Pts with hypertension (OR 3.9) and ReC by TTE (OR 10.8) were the most likely to undergo intervention (p<0.05).
Conclusions: In our study, 16/36 (44%) Sc-CMR detected AoC or at risk aorta. Sc-CMR clearly identifies AoAn, whereas clinical parameters and TTE were not predictive. Sc-CMR leads to earlier intervention and should be performed on all patients with rCOA. Subsequent studies are needed to further define timing of follow-up surveillance CMR.