Cardiovascular Magnetic Resonance Imaging for Comprehensive Risk Assessment in Patients with Aortic Stenosis

T. Lange (Göttingen)¹, B. E. Beuthner (Göttingen)², A. Schulz (Göttingen)¹, S. J. Backhaus (Bad Nauheim)³, R. Evertz (Göttingen)¹, K.-R. Rigorth (Göttingen)¹, K. Toischer (Göttingen)¹, J. Kowallick (Rosdorf)⁴, G. Hasenfuß (Göttingen)¹, M. Puls (Göttingen)¹, A. Schuster (Rosdorf)^4
1Universitätsmedizin Göttingen Herzzentrum, Klinik für Kardiologie und Pneumologie Göttingen, Deutschland; ²University Medical Center Göttingen Department of Cardiology and Pneumology Göttingen, Deutschland; ³Kerckhoff Klinik GmbH Abteilung für Kardiologie Bad Nauheim, Deutschland; ⁴Forum Medizin GbR Kardiologie Rosdorf, Deutschland

Background: Precise risk assessment is essential for accurate management of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). This study aimed to assess the prognostic implications of cardiovascular magnetic resonance (CMR)-derived imaging biomarkers in a large cohort of AS patients.
Methods: 145 patients with severe AS underwent CMR imaging before TAVR. Image analyses included myocardial volumes, CMR-feature-tracking derived left and right atrial (LA & RA) as well as left and right ventricular (LV & RV) strain, myocardial T1 mapping as well as late gadolinium enhancement analyses. Cardiovascular (CV) mortality was defined as primary clinical endpoint.
Results: Patients with CV death during follow-up had significantly enlarged RV enddiastolic volumes (82.9ml/ml² [70.8-96.0] vs. 62.8ml/ml² [54.7-76.0], p<0.001) and impaired strain values of all cardiac chambers compared to patients that survived (LV GLS: -18.1% [-13.1- -20.4] vs. -22.5% [-16.1- -27.3], p=0.019; RV GLS: -22.9% [-18.6 - -25.4] vs. -27.9% [-22.9- -32.0], p=0.002; LA Es: 9.5% [7.2 – 15.4] vs. 14.3% [9.0-18.1], p=0.036; RA Es: 12.4% [6.8-14.4] vs. 16.2% [11.2-22.1], p<0.001). RA reservoir strain independently predicted CV mortality after adjusting for other CMR imaging biomarkers and clinical parameters of heart failure. Within patients with high ECV values especially RA strain further identified AS patients at high-risk for CV mortality (p=0.001 on log-rank testing).
Conclusion: Comprehensive CMR-imaging allows accurate outcome assessment and additional identification of high-risk groups in AS patients. Especially RA strain emerged as independent predictor for cardiovascular mortality and might serve for future optimized patient management.