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Impact of coronary artery disease on systolic function in severe aortic stenosis-a multimodality imaging study

Reetta Hälvä1, Satu Vaara1, Suvi Syväranta1

  • 1Radiology, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

European Heart Journal. Imaging Methods and Practice
|June 12, 2026
PubMed

Insights

Obstructive coronary artery disease (CAD) does not significantly impact left ventricular systolic function in severe aortic stenosis (AS) patients. Intrinsic myocardial disease, not CAD, is linked to reduced global longitudinal strain (GLS).

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Cardiac Physiology

Background:

  • Severe aortic stenosis (AS) often coexists with coronary artery disease (CAD).
  • Assessing left ventricular systolic function is crucial in AS patients undergoing transcatheter aortic valve implantation (TAVI).
  • Global longitudinal strain (GLS) measured by cardiac magnetic resonance (CMR) feature tracking is a sensitive indicator of myocardial function.

Purpose of the Study:

  • To investigate the impact of obstructive CAD and diffuse atherosclerosis on left ventricular systolic function (GLS) in severe AS patients.
  • To differentiate the effects of CAD versus intrinsic myocardial disease on GLS in this population.

Main Methods:

  • Prospective cohort study of 94 severe AS patients undergoing TAVI.
  • Assessment of GLS using CMR feature tracking.
  • Coronary angiography, TAVI computed tomography, and echocardiography were performed.
  • Coronary artery disease (CAD) prevalence and coronary calcium scores were evaluated.

Main Results:

  • The prevalence of obstructive CAD was 21%.
  • GLS was not significantly reduced in patients with obstructive CAD compared to those without.
  • A high coronary calcium score was not associated with GLS.
  • Indexed left ventricular mass and the presence of ischaemic scar on CMR were independently related to reduced GLS.

Conclusions:

  • Obstructive CAD does not significantly impair left ventricular systolic function in severe AS patients.
  • Intrinsic myocardial disease, indicated by left ventricular mass and ischaemic scar, is a key determinant of reduced GLS in severe AS.
  • GLS assessment in AS patients should consider myocardial characteristics beyond epicardial CAD.
Abstract

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