Jyri Lommi

Aims: The aim of this study was to determine the impact of obstructive coronary artery disease (CAD) and diffuse atherosclerosis on left ventricular systolic function, measured as global longitudinal strain (GLS) by cardiac magnetic resonance (CMR) feature tracking, in patients with severe aortic stenosis (AS). Methods and results: In this single-centre prospective cohort study, patients with severe AS and transcatheter aortic valve implantation (TAVI) between October 2018 and February 2022 were referred for transthoracic echocardiography, CMR, and TAVI computed tomography. Invasive coronary angiography was performed before TAVI. Ninety-four patients (80 ± 7 years) were included. The prevalence of obstructive CAD was 20 (21%) patients. The mean GLS in patients with severe AS was −24.0 ± 6.1%, and the median coronary calcium score was 802 (interquartile range 302–2130). GLS was not reduced in patients with obstructive CAD compared to other patients (23.7 ± 5.9% vs. 24.1 ± 6.2%, P = 0.83). A high coronary calcium score was not associated with GLS. Indexed left ventricular mass was independently related to GLS. Patients with an ischaemic scar on CMR had lower GLS (20.3 ± 5.1% vs. 24.6 ± 6.1%, P = 0.02). Conclusion: GLS correlated with left ventricular mass and the presence of ischaemic scar, suggesting that intrinsic myocardial disease, rather than concomitant CAD alone, accounts for reduced GLS in this population.

Aims: To assess the prognosis of patients with coronary heart disease (CHD) after first myocardial revascularisation procedure in real-world practice and to compare the differences in outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) among diabetic and non-diabetic patients.Methods and results: A database was compiled from the national hospital discharge register to collect data on all cardiac revascularisations performed in Finland in 2000–2015. The outcomes (all-cause deaths, cardiovascular (CV) deaths, major CV events and need for repeat revascularisation) after the first revascularisation were identified from the national registers at 28 day, 1 year, and 3 year time points.A total of 139 242 first-time revascularisations (89 493 PCI and 49 749 CABG) were performed during the study period. Of all the revascularised patients, 24% had diabetes, and 76% were non-diabetic patients. At day 28, the risk of fatal outcomes was lower after PCI than after CABG among non-diabetic patients, whereas no difference was seen among diabetic patients. In long-term follow-up the situation was reversed with PCI showing higher risk compared with CABG for most of the outcomes. In particular, at 3 year follow-up the risk of all-cause deaths was elevated among diabetic patients [HR 1.30 (95% CI 1.22–1.38) comparing PCI with CABG] more than among non-diabetic patients [HR 1.09 (1.04–1.15)]. The same was true for CV deaths [HR 1.29 (1.20–1.38) among diabetic patients, and HR 1.03 (0.98–1.08) among non-diabetic patients].Conclusion: Although PCI was associated with better 28 day prognosis, CABG seemed to produce better long-term prognosis especially among diabetic patients.