Reduced Pulmonary Artery Distensibility Predicts Persistent Pulmonary Hypertension and 2-Year Mortality in Patients with Severe Aortic Stenosis Undergoing TAVR
Copyright © 2023 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved..
RATIONALE AND OBJECTIVES: Post-TAVR persistent pulmonary hypertension (PH) is a better predictor of poor outcome than pre-TAVR PH. In this longitudinal study we sought to evaluate whether pulmonary artery (distensibility (DPA) measured on preprocedural ECG-gated CTA is associated with persistent-PH and 2-year mortality after TAVR.
MATERIALS AND METHODS: Three hundred and thirty-six patients undergoing TAVR between July 2012 and March 2016 were retrospectively included and followed for all-cause mortality until November 2017. All patients underwent retrospectively ECG-gated CTA prior to TAVR. Main pulmonary artery (MPA) area was measured in systole and in diastole. DPA was calculated as: [(area-MPAmax-area-MPAmin)/area-MPAmax]%. ROC analysis was performed to assess the AUC for persistent-PH. Youden Index was used to determine the optimal threshold of DPA for persistent-PH. Two groups were compared based on a DPA threshold of 8% (specificity of 70% for persistent-PH). Kaplan-Meier, Cox proportional-hazard, and logistic regression analyses were performed. The primary clinical endpoint was defined as persistent-PH post-TAVR. The secondary endpoint was defined as all-cause mortality 2 years after TAVR.
RESULTS: Median follow-up time was 413 (interquartiles 339-757) days. A total of 183 (54%) had persistent-PH and 68 (20%) patients died within 2-years after TAVR. Patients with DPA<8% had significantly more persistent-PH (67% vs 47%, p<0.001) and 2-year deaths (28% vs 15%, p=0.006), compared to patients with DPA>8%. Adjusted multivariable regression analyses showed that DPA<8% was independently associated with persistent-PH (OR 2.10 [95%-CI 1.3-4.5], p=0.007) and 2-year mortality (HR 2.91 [95%-CI 1.5-5.8], p=0.002). Kaplan-Meier analysis showed that 2-year mortality of patients with DPA<8% was significantly higher compared to patients with DPA≥8% (mortality 28% vs 15%; log-rank p=0.003).
CONCLUSION: DPA on preprocedural CTA is independently associated with persistent-PH and two-year mortality in patients who undergo TAVR.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:30 |
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| Enthalten in: |
Academic radiology - 30(2023), 12 vom: 16. Dez., Seite 2825-2833 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Turner, Valery [VerfasserIn] |
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| Links: |
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| Themen: |
Computed tomography angiography |
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| Anmerkungen: |
Date Completed 01.12.2023 Date Revised 10.03.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.acra.2023.03.014 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM356503321 |
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| 100 | 1 | |a Turner, Valery |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Reduced Pulmonary Artery Distensibility Predicts Persistent Pulmonary Hypertension and 2-Year Mortality in Patients with Severe Aortic Stenosis Undergoing TAVR |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Completed 01.12.2023 | ||
| 500 | |a Date Revised 10.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a RATIONALE AND OBJECTIVES: Post-TAVR persistent pulmonary hypertension (PH) is a better predictor of poor outcome than pre-TAVR PH. In this longitudinal study we sought to evaluate whether pulmonary artery (distensibility (DPA) measured on preprocedural ECG-gated CTA is associated with persistent-PH and 2-year mortality after TAVR | ||
| 520 | |a MATERIALS AND METHODS: Three hundred and thirty-six patients undergoing TAVR between July 2012 and March 2016 were retrospectively included and followed for all-cause mortality until November 2017. All patients underwent retrospectively ECG-gated CTA prior to TAVR. Main pulmonary artery (MPA) area was measured in systole and in diastole. DPA was calculated as: [(area-MPAmax-area-MPAmin)/area-MPAmax]%. ROC analysis was performed to assess the AUC for persistent-PH. Youden Index was used to determine the optimal threshold of DPA for persistent-PH. Two groups were compared based on a DPA threshold of 8% (specificity of 70% for persistent-PH). Kaplan-Meier, Cox proportional-hazard, and logistic regression analyses were performed. The primary clinical endpoint was defined as persistent-PH post-TAVR. The secondary endpoint was defined as all-cause mortality 2 years after TAVR | ||
| 520 | |a RESULTS: Median follow-up time was 413 (interquartiles 339-757) days. A total of 183 (54%) had persistent-PH and 68 (20%) patients died within 2-years after TAVR. Patients with DPA<8% had significantly more persistent-PH (67% vs 47%, p<0.001) and 2-year deaths (28% vs 15%, p=0.006), compared to patients with DPA>8%. Adjusted multivariable regression analyses showed that DPA<8% was independently associated with persistent-PH (OR 2.10 [95%-CI 1.3-4.5], p=0.007) and 2-year mortality (HR 2.91 [95%-CI 1.5-5.8], p=0.002). Kaplan-Meier analysis showed that 2-year mortality of patients with DPA<8% was significantly higher compared to patients with DPA≥8% (mortality 28% vs 15%; log-rank p=0.003) | ||
| 520 | |a CONCLUSION: DPA on preprocedural CTA is independently associated with persistent-PH and two-year mortality in patients who undergo TAVR | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Computed tomography angiography | |
| 650 | 4 | |a Pulmonary artery | |
| 650 | 4 | |a Pulmonary hypertension | |
| 650 | 4 | |a Transcatheter aortic valve replacement | |
| 700 | 1 | |a Maret, Eva |e verfasserin |4 aut | |
| 700 | 1 | |a Kim, Juyong B |e verfasserin |4 aut | |
| 700 | 1 | |a Codari, Marina |e verfasserin |4 aut | |
| 700 | 1 | |a Hinostroza, Virginia |e verfasserin |4 aut | |
| 700 | 1 | |a Mastrodicasa, Domenico |e verfasserin |4 aut | |
| 700 | 1 | |a Watkins, A Claire |e verfasserin |4 aut | |
| 700 | 1 | |a Fearon, William F |e verfasserin |4 aut | |
| 700 | 1 | |a Fischbein, Michael P |e verfasserin |4 aut | |
| 700 | 1 | |a Haddad, Francois |e verfasserin |4 aut | |
| 700 | 1 | |a Willemink, Martin J |e verfasserin |4 aut | |
| 700 | 1 | |a Fleischmann, Dominik |e verfasserin |4 aut | |
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