The impact of computed tomography-derived aortic atheroma volume on prognosis after transcatheter aortic valve replacement

Hiroshi Fujita,Takayoshi Toba,Keisuke Miwa,Masataka Suzuki,Yu Takahashi,Hiroyuki Toh,Yu Izawa,Hiroyuki Kawamori,Hiromasa Otake,Sei Fujiwara,Yoshiaki Watanabe,Atsushi Kono,Ken-Ichi Hirata

doi:10.1016/j.ijcard.2021.09.053

Hiroshi Fujita, Takayoshi Toba + Show 11 more

Open Access

https://doi.org/10.1016/j.ijcard.2021.09.053

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Abstract

BackgroundThe impact of the extent of aortic atheroma on patients' prognosis after transcatheter aortic valve replacement (TAVR) has not been completely evaluated. This study aimed to evaluate the prognostic value of the aortic atheroma volume (AAV) derived from computed tomography, and the effect of its differences among the segments of the aorta, in patients undergoing TAVR. MethodsIn total, 143 patients with symptomatic severe aortic stenosis who underwent pre-procedural computed tomography before TAVR procedure indication were evaluated. AAV was calculated by measuring the aortic lumen and vessel volume using every 1-mm axial image and was further divided into thoracic (TAAV) and abdominal segments (AbAAV). ResultsDuring a median follow-up of 651 days, 24 all-cause and 14 cardiac deaths occurred. In the Kaplan-Meier analysis, the high AAV group had significantly higher all-cause and cardiac mortalities than the low AAV group (p = 0.016 and 0.023, respectively). Regarding segmental AAV, all-cause and cardiac mortalities did not have significant differences between the high and low TAAV groups. Moreover, all-cause and cardiac mortalities were significantly higher in the high AbAAV group than in the low AbAAV group (p = 0.0043 and 0.023, respectively). The multivariable analysis showed that only AbAAV was an independent predictor for all-cause mortality (hazard ratio: 1.06, p = 0.046). ConclusionAAV was significantly associated with the mortality after TAVR. The current study suggests the pre-procedural assessment of AAV is valuable in predicting prognosis after TAVR. However, further investigation with a larger sample size is needed to validate our findings.

Highlights

Transcatheter aortic valve replacement (TAVR) is a widely accepted treatment for patients with severe aortic stenosis (AS), for the elderly population or those with multiple comorbidities [1,2,3,4,5]
Images for measuring atheroma volume (AAV) were reconstructed with a 1-mm slice thickness
143 patients were analyzed in this study

Summary

Introduction

Transcatheter aortic valve replacement (TAVR) is a widely accepted treatment for patients with severe aortic stenosis (AS), for the elderly population or those with multiple comorbidities [1,2,3,4,5]. Technical advancements in TAVR enhance procedural success and mitigate peri-procedural complications, some patients who undergo TAVR have a subtle improvement in symptoms and eventually die in the early phase after TAVR [6,7]. This study aimed to evaluate the prognostic value of the aortic atheroma volume (AAV) derived from computed tomography, and the effect of its differences among the segments of the aorta, in patients undergoing TAVR. In the Kaplan-Meier analysis, the high AAV group had significantly higher all-cause and cardiac mortalities than the low AAV group (p = 0.016 and 0.023, respectively). Regarding segmental AAV, all-cause and cardiac mortalities did not have significant differences between the high and low TAAV groups. All-cause and cardiac mortalities were significantly higher in the high AbAAV group than in the low AbAAV group (p = 0.0043 and 0.023, respectively). Further investigation with a larger sample size is needed to validate our findings

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