Cardiac damage grading in patients with aortic stenosis using multi-detector computed tomography and the impact on prognosis after transcatheter aortic valve intervention. (25th November 2020)

• Record Type: Journal Article
• Authors: Hirasawa, K; Rosendael, P.J; Fortuni, F; Singh, G.K; Kuneman, J; Vollema, E.M; Ajmone Marsan, N; Delgado, V; Bax, J.J
• Is Part Of: European heart journal. Volume 41:(2020)Supplement 2
• Publication Date: 2020-11-25
• Subjects: Computed Tomography: Valve Disease; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/ehjci/ehaa946.0164
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Introduction: A staging of severe aortic stenosis (AS) based on additional extra-valvular cardiac damage has been associated with prognosis after transcatheter aortic valve implantation (TAVI). Multi-detector row computed tomography (MDCT) has a central role in the evaluation of AS patients undergoing TAVI and can detect extra-valvular cardiac damage. Purpose: To evaluate the prognostic implications of an MDCT staging system of severe AS in patients undergoing TAVI. Methods: Patients who underwent full-beat MDCT prior to TAVI were included. Patients with intra-cardiac devices, prior valvular surgery, and insufficient image quality were excluded. The extent of cardiac damage was assessed by MDCT and classified into following 5 groups; stage 0 (no cardiac damage), stage 1 (left ventricular damage), stage 2 (left atrium and mitral valve damage), stage 3 (right atrial damage), stage 4 (right ventricular damage). The primary end-point was all-cause mortality. Results: A total of 405 patients (80±7 years, 52% men) were stratified according to the MDCT staging system: 27 (7%) were in stage 0, 96 (24%) in stage 1, 152 (38%) in stage 2, 78 (19%) in stage 3, and 52 (13%) in stage 4 (left panel). During follow-up (median 3.7 years, IQR: 1.7–5.5 years), 150 (37%) died (right panel). On multivariable analysis, cardiac damage stage, presence of chronic obstructive pulmonary disease, NYHA ≥3, eGFR, and transapical approach were independently associated with all-cause mortality. When evaluating each stage, stage 3 (HR: 4.725, P=0.033) and stage 4 (HR 5.678, P=0.018) were independently associated with worse outcomes as compared to the other stages. Conclusion: MDCT-based staging system of severe AS identifies the patients who are at higher risk of death after TAVI. Funding Acknowledgement: Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): ESC research grant