BACKGROUND: Transcatheter aortic valve implantation (TAVI) is a viable option for aortic stenosis (AS) patients. Data to assess whether patients with left ventricular (LV) dysfunction may benefit from TAVI, is limited. We aimed to characterize the myocardium of patients with LV dysfunction by cardiac magnetic resonance (CMR).
METHODS: TAVI candidates with low ejection fraction (EF≤40%) were prospectively enrolled. CMR ( 1.5 T scanner) included: SSFP (function quantification) and late Gadolinium enhancement (LGE) (myocardial characterization). LGE was quantified in short axis plane as % of the LV mass. Subendocardial LGE present in a distinct coronary territory was considered as ischemic (ISCLGE), LGE in different distribution was considered non ischemic (NONISCLGE). All patients underwent baseline transthoracic echocardiography (TTE) and post procedural follow up.
RESULTS: A total of 7 male patients were enrolled; average age was 83±5 with average STS of 6.4±3.2%. LVEF by TTE was 32±11% and by CMR 34±9%. LV end-diastolic diameter by TTE was 55±5 mm, and by CMR 57±6mm. NONISCLGE was documented in 6/7 patients with an average of 8.5±6% of LV mass. NONISCLGE was demonstrated in an epicardial or midwall distribution in the septum and lateral wall. ISCLGE was found in 3/7 patients with an average of 6.3±9 % of LV mass. TAVI was performed in 5/7 patients.
CONCLUSIONS: Patients with severe AS and severely impaired LVEF are a unique subset of TAVI patients with high procedural risk and questionable long term benefit. The current study demonstrated that LGE is very common in these patients both as a non- ischemic and ischemic pattern. The characteristic LGE features shown in this preliminary study may serve in the future as a tool to predict which patients with severe LV dysfunction will benefit from TAVI and in which patients this procedure may be futile.
