Objectives: The purpose of the study was to assess the association between left ventricular mass (LVM) and coronary blood volume (CBV) in patients with symptomatic severe aortic stenosis (AS) referred for transcatheter aortic valve implantation.
Background: Mismatch between LVM and CBV is a well known phenomenon in symptomatic patients with left ventricular hypertrophy; however, quantitative assessment of CBV in relationship to LVM has not been done before.
Methods: Seventy-three patients (80.6 ± 6.9 years) with symptomatic severe aortic stenosis and seventeen normal subjects underwent retrospective contrast-enhanced 256-slice computed tomography (CT). Only patients with normal CT coronary angiogram and symptoms of angina were included. The CT images were reconstructed in 10% increments over the whole cardiac cycle to obtain LVM for the entire left ventricle and to measure CBV for the entire coronary tree. The LVM/CBV index was calculated.
Results: Compared with normal subjects patients with severe AS had significantly higher LVM index (79.79 ± 18.15 g/m2 vs. 53.21 ± 9.77 g/m2, P < 0.002; respectively) and a trend towards higher CBV (4.04ml ± 1.29 vs. 3.51 ± 0.65 ml, P = 0.091; respectively). In patients with AS the LVM/CBV index was significantly increased (39.2 ± 19.9 vs. 29.3 ± 7.5, P = 0.05; respectively), and CBV was not correlated to LVM (R = 0.2, P = 0.17), which emphasize the mismatch between LV hypertrophy and CBV.
Conclusion: Patients with symptomatic severe AS and left ventricular hypertrophy have slight increased CBV, which is not correlated to a significant increase in LVM. The mismatch between CBV and LVM in patients with severe AS and normal coronary angiogram could in part explain the symptoms of angina.
