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Prognostic value of computer tomography derived measurements of pulmonary artery diameter on long term outcomes after transcatheter aortic valve replacement

Łukasz Kalińczuk1, Zbigniew Chmielak2, Maciej Dąbrowski2, Marcin Mazurkiewicz1, Patrycjusz Stokłosa3, Wiktor Skotarczak2, Gary S Mintz4, Rafał Wolny2, Paweł Tyczyński2, Marek Konka5, Anna Michałowska6, Ilona Kowalik7, Marcin Demkow1, Ilona Michałowska6, Adam Witkowski2
DOI: 10.33963/KP.a2022.0173
·
Pubmed: 35892248
Affiliations
  1. Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warszawa, Poland
  2. Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warszawa, Poland
  3. Department of Valvular Cardiac Defects, National Institute of Cardiology, Warszawa, Poland
  4. Cardiovascular Research Foundation, New York, NY, United States
  5. Department of Congenital Heart Diseases, National Institute of Cardiology, Warszawa, Poland
  6. Department of Radiology, National Institute of Cardiology, Warszawa, Poland
  7. Department of Coronary Artery Disease and Cardiac Rehabilitation, National Institute of Cardiology, Warszawa, Poland

open access

Online first
Original article
Published online: 2022-07-25

Abstract

Background: Increase in pulmonary artery diameter (PAD) in multi-detector computed tomography (MDCT) may indicate pulmonary hypertension. We assessed the prognostic value of MDCT-derived measurements of pulmonary artery diameter (PAD) on outcomes after successful transcatheter aortic valve replacement (TAVR).

Methods: Consecutive patients  treated with TAVR from 02/2013 to 10/2017 with a 68.8% rate of new generation valves, underwent pre-interventional MDCT with measurements of PAD (in the widest short-axis within 3 cm of the bifurcation) and ascending aortic diameter (AoD; at the level of the PAD). PAD/AoD ratio was calculated. Patients with high-density lipoprotein cholesterol level ≤46 mg/dl and C-reactive protein level ≥0.20 mg/dl at baseline were identified as the frail group. The 1-year mortality was established for all subjects.

Results: Among studied 266 patients (median age, 82.0 years; 63.5% women) those who died at 1-year (n = 34; 12.8%) had larger PAD and PAD/AoD (28.9 [5.0] vs. 26.5 [4.6] mm and 0.81 [0.13] vs. 0.76 [0.13] vs. the rest of the studied subjects; P = 0.005 and P = 0.02, respectively), but similar AoD. Cutoff value for the PAD to predict 1-year mortality was 29.3 mm (sensitivity, 50%; specificity, 77%; area under the curve, 0.65). Patients with PAD >29.3 mm (n = 72; 27%) had higher 1-year mortality (23.6% vs. 8.8%, log-rank P = 0.001). Baseline characteristics associated with PAD >29.3 mm were bigger body mass index, more frequent diabetes mellitus, more prior stroke/transient ischemic attack and atrial fibrillation, and lower baseline maximal aortic valve gradient with higher pulmonary artery systolic pressure (PASP). PAD >29.3 mm and frailty, but not baseline PASP, remained predictive of 1-year mortality in the multivariable model (hazard ratio [HR], 2.221; 95% CI, 1.038–4.753; P = 0.04 and HR, 2.801; 95% CI, 1.328–5.910; P = 0.007, respectively).

Conclusion: PAD >29.3 mm in baseline MDCT is associated with higher 1-year mortality after TAVR, independently of echocardiographic measure of PH and frailty.

Abstract

Background: Increase in pulmonary artery diameter (PAD) in multi-detector computed tomography (MDCT) may indicate pulmonary hypertension. We assessed the prognostic value of MDCT-derived measurements of pulmonary artery diameter (PAD) on outcomes after successful transcatheter aortic valve replacement (TAVR).

Methods: Consecutive patients  treated with TAVR from 02/2013 to 10/2017 with a 68.8% rate of new generation valves, underwent pre-interventional MDCT with measurements of PAD (in the widest short-axis within 3 cm of the bifurcation) and ascending aortic diameter (AoD; at the level of the PAD). PAD/AoD ratio was calculated. Patients with high-density lipoprotein cholesterol level ≤46 mg/dl and C-reactive protein level ≥0.20 mg/dl at baseline were identified as the frail group. The 1-year mortality was established for all subjects.

Results: Among studied 266 patients (median age, 82.0 years; 63.5% women) those who died at 1-year (n = 34; 12.8%) had larger PAD and PAD/AoD (28.9 [5.0] vs. 26.5 [4.6] mm and 0.81 [0.13] vs. 0.76 [0.13] vs. the rest of the studied subjects; P = 0.005 and P = 0.02, respectively), but similar AoD. Cutoff value for the PAD to predict 1-year mortality was 29.3 mm (sensitivity, 50%; specificity, 77%; area under the curve, 0.65). Patients with PAD >29.3 mm (n = 72; 27%) had higher 1-year mortality (23.6% vs. 8.8%, log-rank P = 0.001). Baseline characteristics associated with PAD >29.3 mm were bigger body mass index, more frequent diabetes mellitus, more prior stroke/transient ischemic attack and atrial fibrillation, and lower baseline maximal aortic valve gradient with higher pulmonary artery systolic pressure (PASP). PAD >29.3 mm and frailty, but not baseline PASP, remained predictive of 1-year mortality in the multivariable model (hazard ratio [HR], 2.221; 95% CI, 1.038–4.753; P = 0.04 and HR, 2.801; 95% CI, 1.328–5.910; P = 0.007, respectively).

Conclusion: PAD >29.3 mm in baseline MDCT is associated with higher 1-year mortality after TAVR, independently of echocardiographic measure of PH and frailty.

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Keywords

TAVR, pulmonary hypertension, pulmonary artery diameter

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Title

Prognostic value of computer tomography derived measurements of pulmonary artery diameter on long term outcomes after transcatheter aortic valve replacement

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Online first

Article type

Original article

Published online

2022-07-25

Page views

59

Article views/downloads

22

DOI

10.33963/KP.a2022.0173

Pubmed

35892248

Keywords

TAVR
pulmonary hypertension
pulmonary artery diameter

Authors

Łukasz Kalińczuk
Zbigniew Chmielak
Maciej Dąbrowski
Marcin Mazurkiewicz
Patrycjusz Stokłosa
Wiktor Skotarczak
Gary S Mintz
Rafał Wolny
Paweł Tyczyński
Marek Konka
Anna Michałowska
Ilona Kowalik
Marcin Demkow
Ilona Michałowska
Adam Witkowski

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