Coronary Artery Disease Assessed by Computed Tomography-Based Leaman Score in Patients With Low-Risk Transcatheter
Yuichi Ozaki1, Hector M Garcia-Garcia1, Toby Rogers2
1Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
Insights
Low-risk patients undergoing transcatheter aortic valve implantation (TAVI) often have significant coronary artery disease (CAD) burden, as indicated by the CT Leaman score. This finding highlights the need for TAVI devices that allow unimpeded coronary access.
Area of Science:
- Cardiology
- Radiology
- Interventional Cardiology
Background:
- Coronary artery disease (CAD) extent in low-risk patients undergoing transcatheter aortic valve implantation (TAVI) is not well-quantified.
- The CT Leaman score, derived from coronary CT angiography (CCTA), quantifies atherosclerotic burden and predicts major adverse cardiac events.
- A CT Leaman score >5 is associated with increased long-term adverse cardiac events.
Purpose of the Study:
- To evaluate the coronary artery disease (CAD) burden using the CT Leaman score in low-risk patients selected for transcatheter aortic valve implantation (TAVI).
- To assess the prevalence of significant CAD in this patient cohort using CCTA.
- To inform the design of future TAVI devices regarding coronary access.
Main Methods:
- Utilized data from the Low Risk TAVI trial, including patients who underwent CCTA prior to TAVI.
- Calculated the CT Leaman score using plaque location, type, and degree of stenosis from CCTA.
- Analyzed CCTA images from 169 eligible patients.
Main Results:
- The mean CT Leaman score was 6.27 ± 0.27 among the 169 analyzed patients.
- A significant proportion (60.4%) had a CT Leaman score >5, indicating substantial CAD burden.
- Nearly all patients (97%) exhibited coronary plaques, with 19.5% having potentially obstructive proximal plaques (>50% stenosis).
Conclusions:
- Low-risk TAVI patients frequently present with a significant coronary artery disease burden.
- The CT Leaman score effectively quantifies CAD in this population.
- Future transcatheter aortic valve implantation device development should prioritize unimpeded coronary artery access for angiography and interventions.
Abstract:
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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