LGE helps ID at-risk aortic valve replacement patients

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 - surgery

The presence of late gadolinium enhancement (LGE) on cardiac MR predicted perioperative risk and worse survival in patients with severe aortic stenosis who were to undergo surgical aortic valve replacement (SAVR), according to a study published in the July 15 issue of the Journal of the American College of Cardiology.

Gilles Barone-Rochette, MD, of the valvular heart disease clinic at Cliniques Universitaires Saint-Luc in St. Lambert, Belgium, and colleagues conducted a prospective study to evaluate the prognostic value of LGE-cardiac MR to predict post-operative survival in patients with severe aortic stenosis who underwent SAVR. The study also included a second group who underwent transcatheter aortic valve replacement (TAVR).

The researchers enrolled 154 consecutive patients with severe aortic stenosis as well as 40 for the TAVR assessment. Patients underwent cardiac MR a median three days before surgery.

At a median 2.9 years, 21 patients in the SAVR group died, with 11 of cardiovascular disease-related causes. Patients with significant preoperative LGE had worse all-cause and cardiovascular disease-related survival compared with no LGE, mostly driven by an increase in post-operative mortality. Higher amounts of LGE predicted worse survival after surgery.

In the TAVR group, 20 patients died at a median follow-up of 3.9 years, with 15 from cardiovascular causes. LGE presence predicted worse cardiovascular disease-related survival in the subgroup who underwent transfemoral TAVR but not those treated transapically.

They suggested that LGE-cardiac MR might become a new way to preoperatively assess risk in patients with severe aortic stenosis.

“[T]he absence of LGE-CMR in patients with severe AS [aortic stenosis] appears to identify patients at low risk for surgery, with excellent long-term survival, who might benefit from early surgery,” Barone-Rochette et al wrote. “On the other hand, patients with high degrees of LGE, indicating higher post-operative risk and lower survival, could be candidates for TAVR, although we also found that LGE predicted worse outcome after transfemoral TAVR.”