Abstract 9109: Incremental Prognostic Value of MDCT Findings for Predicting Symptomatic Deterioration and Major Adverse Cardiac Events in Patients with Aortic Stenosis
Background: Currently, management of aortic stenosis (AS) is based on the presence of symptoms, disease severity (peak transaortic velocity; Vpeak) and left ventricular (LV) function determined by echocardiography, and the concomitant coronary artery disease detected by cardiac catheterization. Multidetector computed tomography (MDCT) can provide a simultaneous evaluation of valvular morphology, ventricular function, and coronary anatomy. We sought to determine the prognostic value of MDCT findings in patients with AS and, in particular, the incremental prognostic value as compared with clinical symptoms and Vpeak.
Methods: A total of 46 patients (74 ± 7 years; 61% women)with AS underwent echocardiography and 64-MDCT to evaluate aortic valve area (AVA), LV ejection fraction, LV mass index (LVMI), the presence of obstructive coronary artery disease, and aortic valve calcification score (AVCS). Patients were followed up as to symptomatic deterioration and major adverse cardiac events (cardiac death, nonfatal myocardial infarction, aortic valve replacement (AVR), and heart failure requiring hospitalization).
Results: Vpeak averaged 3.53 ± 1.16 m/sec (range, 1.97 to 6.21 m/sec). During a mean follow-up of 21.8 ± 13.2 months, 21 events occurred in 19 patients (6 symptomatic deterioration, 3 cardiac death, 3 unstable angina, 6 AVR, and 3 heart failure). Vpeak measured by echocardiography showed a statistically significant incremental prognostic value as compared to baseline clinical symptoms (p = 0.006), whereas MDCT provided an additional incremental prognostic value as compared with baseline clinical symptoms plus Vpeak if considering both MDCT-derived AVA (per 0.1cm2 decrease, HR [95%CI] 1.14 [1.01-1.28], p = 0.031; incremental value, p = 0.027), or better, MDCT-derived LVMI (per 1-SD increase, 2.04 [1.27-3.27], p = 0.003; incremental value, p = 0.006). Among cardiac MDCT findings, AVCS measured by non-contrast enhanced CT had the strongest incremental prognostic value (per 100 Agatston Unit increase, 1.21 [1.11-1.32], p < 0.001; incremental value, p < 0.0001).
Conclusions: MDCT provides independent and incremental prognostic information as compared to baseline clinical symptoms and echocardiographic Vpeak in patients with AS.
- © 2011 by American Heart Association, Inc.