Abstract 10955: Masked Coronary Artery Disease in Asymptomatic Patients With Severe Aortic Stenosis and Normal Exercise Testing.

Introduction: There are no data about the prevalence of masked/latent coronary artery disease (CAD) in asymptomatic patients with severe aortic stenosis (AS) and normal exercise testing (ET) Hypothesis: We hypothesized there will be masked CAD in asymptomatic severe AS patients with normal ET. Importantly, this phenomena could influence the choice and timing of treatment in these patients Methods: We analyzed patients from the cohort screened for Avatar trial eligibility (NCT02436655). ET was performed on semi-supine ergobicycle.Cardiopulmonary analysis during ET (CPET) as well as comprehensive echo and laboratory analysis at rest was done.Standard clinical and ECG criteria were assessed for symptoms and signs of ischemia during and after ET. At least 80% of maximal heart rate had to be achieved in order for ET to be conclusive. In patients with normal ET, coronary angiography (CA) was performed using the standard percutaneous femoral/radial approach. Coronary stenosis was considered significant if >70% of vessel diameter or 50-70% with Fractional Flow Reserve ≤0.8 Results: Total of 92 patients with normal ET were included in this analysis (mean age 67.62±9.68, 51.4% males). During the testing or recovery phase no patient had any complication or adverse event. The Pmean was 52.71±11.67 mmHg, mean AVAi 0.36±0.08cm2/m2, mean LVEF 69.51%±7.51%. 18/92 patients (19.54%) had CAD on CA. There was no difference in analyzed CPET, echo parameters and valvulo-arterial impedance between patients with and without CAD (p>0.05). When we compared patients depending on whether they had one-vessel (10/18 pts) or multivessel/left main CAD there was no difference in any of the parameters (p>0.05).According to multivariate logistic regression analysis BNP and blood glucose were independent predictors of masked CAD. The BNP value of 118 pg/ml had sensitivity and specificity of 63 and 73% for predicting CAD in asymptomatic severe AS patients with normal LVEF (AUC 0.727, p=0.006), figure 1. Conclusions: Results of this study are the first to show the prevalence of masked CAD in asymptomatic patients with severe AS, normal LVEF and normal ET. Even in patients with normal ET, significant CAD is present in as many as 1/5 patients. BNP might be of help to suspect patients with latent CAD [ABSTRACT FROM AUTHOR]