Noninvasive Coronary Sinus Oximetry by CMR Reveals Metabolic Recovery After TAVR in Aortic Stenosis

Saturday, February 7, 2026

11:10 AM - 11:20 AM

Location: Americas I and Hall 3 (2nd Lower Level)

Presenting Author(s)

CY

Chia-Chi Yang, MSc

PhD Student
Cedars-Sinai Medical Center, Los Angeles, CA, United States
Los Angeles, California, United States

Primary Author(s)

CY

Chia-Chi Yang, MSc

PhD Student
Cedars-Sinai Medical Center, Los Angeles, CA, United States
Los Angeles, California, United States

Co-Author(s)

HZ

Henghui Zhang, MD

Radiologist
The First Hospital of China Medical University
Shenyang, Liaoning, China (People's Republic)
Li-Ting Huang, MD, MSc

radiologist
National Cheng Kung University Hospital
Los Angeles, California, United States
RZ

Ranran Zhang, MD

Radiologist
The First Hospital of China Medical University
Shenyang, Liaoning, China (People's Republic)
AM

Archana V. Malagi, PhD

Postdoctoral Scientist
Cedars-Sinai Medical Center
Los Angeles, California, United States
YH

Yuheng Huang, PhD

Postdoctoral Scientist
Cedars-Sinai Medical Center
Los Angeles, California, United States
Xinheng Zhang, PhD

Postdoctoral Scientist
Cedars-Sinai Medical Center
Redwood City, California, United States
HL

Hsu-Lei Lee, PhD

MR Physicist
Cedars-Sinai Medical Center
Los Angeles, California, United States
GT

George Thornton

Postdoctoral Scientist
Cedars-Sinai Medical Center, United States
HA

Hasanian Al-Jilaihawi

Staff Physician II
Cedars-Sinai Medical Center, United States
Xiaoming Bi, PhD

Director, Cardiovascular MR Collaborations
Siemens Medical Solutions USA, Inc.
Oak Park, California, United States
CG

Chang Gao, PhD

Sr Scientist
Siemens Healthineers
LA, California, United States
Anthony G. Christodoulou

Associate Professor
University of California, Los Angeles (UCLA)
Los Angeles, California, United States
Debiao Li, PhD

Professor
Cedars Sinai Medical Center
Los Angeles, California, United States
Rohan Dharmakumar, PhD

Executive Director
Indiana University School of Medicine
Indianapolis, Indiana, United States
GW

Guan Wang, MD

Radiologist
The First Hospital of China Medical University
Shenyang, Liaoning, China (People's Republic)
Hsin-Jung (Randy) Yang, PhD

Associate Professor
Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
Los Angeles, California, United States

Background: Aortic stenosis (AS) is a progressive and life-threatening disease that narrows the aortic valve, restricts LV outflow, and increases myocardial oxygen demand. Impaired coronary flow reserve in AS can limit oxygen delivery, resulting in reduced coronary sinus (CS) oxygen saturation (ScsO₂) and elevated myocardial oxygen extraction fraction (OEF) [1]. Accurate assessment of myocardial oxygen metabolism is critical for staging disease and monitoring therapeutic response, but current methods are invasive, require ionizing radiation, or indirect. A rapid, noninvasive CMR approach to quantify ScsO₂ and OEF could provide a transformative biomarker for metabolic stress in AS.

Methods: We studied 21 patients with severe AS (5 imaged both pre- and post-TAVR) and 13 age- and sex-matched healthy controls. Imaging was performed on a 3T scanner (MAGNETOM Vida, Siemens Healthineers, Germany) using a free-breathing, non-ECG-gated, motion-resolved 3D radial GRE T₂-prepared inversion recovery (T₂-Prep-IR) sequence targeting the CS [2]. Data were reconstructed using a low-rank tensor (LRT) framework incorporating blood-oxygenation signal modeling to generate pixelwise ScsO₂ maps. OEF was calculated as (SaO₂ – ScsO₂)/SaO₂. A schematic overview of the technique is shown in Figure 1.

Results: All subjects completed imaging with high-quality ScsO₂ maps. Compared to pre-TAVR, post-TAVR patients demonstrated significantly higher ScsO₂ and reduced OEF (N=5: ScsO₂ 40.2±16.4% → 48.8±7.8%, Δ+8.6%, p< 0.05; OEF 56.8±17.8% → 48.3±8.9%, Δ–8.5%, p=0.05). Relative to healthy controls, pre-TAVR patients trended toward lower ScsO₂ and higher OEF (ScsO₂: 41.5±10.9% vs. 46.8±9.5%, Δ–5.3%, p=0.07; OEF: 56.1±11.3% vs. 51.0±9.4%, Δ+5.1%, p=0.08). Post-TAVR patients showed normalization to levels comparable with controls (ScsO₂ p=0.33; OEF p=0.30). Representative maps are shown in Figure 2, with group results summarized in Figure 3.

Conclusion: We demonstrate the feasibility of noninvasive, contrast-free CMR method for quantifying coronary sinus oxygenation and myocardial oxygen extraction in AS patients. This technique detects impaired oxygen metabolism in AS and reveals metabolic recovery following TAVR, providing novel functional insights beyond anatomy. These findings establish coronary sinus CMR oximetry as a promising biomarker for staging, risk stratification, and therapy monitoring in AS, with strong translational potential for guiding individualized patient management.

Fig. 1 The CMR oximetry flowchart. Panel (A) shows the sequence diagram of the proposed T2prep-IR sequence for data acquisition with 6 inter-echo spacing = 0, 7.5, 15, 22.5, 27.5 and 30 ms. Panel (B) demonstrates the LRT reconstruction process [3] to generate the motion resolved images. During reconstruction, the SbO2 sensitive signal progression dimension was estimated by the Bloch equation and the T1&T2 L-M model. Panel (C) displays the formula of it [4][5]. After reconstruction, the SbO2 maps are generated.

Fig. 2 Representative Images of Cine and the Oximetry Images. Panel (A) shows the bSSFP Cine images of one patient’s CS cross-section views before and after TAVR. Panel (B) represents the corresponding reconstructed motion-resolved SbO2 weighted images. Panel (C) demonstrates the SbO2 maps fitted from (B). We can observe that the ScsO2 increases after TAVR (ΔScsO2 =6.96%).

Fig. 3 Quantitative comparison between patients pre TAVR, post TAVR and healthy controls. Panel (A), (B) compares the patients’ ScsO2 and OEF before and after surgery, and the paired t-test result shows that after surgery, the patient’s ScsO2 increases and OEF decreases significantly. Panel (C), (D) compares the patients’ ScsO2 and OEF to the healthy controls, and the two sample t-test result shows that patients pre TAVR have a trend to have lower ScsO2 and higher OEF, while the difference between patients post TAVR and healthy controls are not significant.