CT findings of right heart failure before TAVR predicts mortality, finds study
USA: Imaging features of right heart failure seen on CT performed before TAVR is associated with increased death risk within the first year after TAVR, according to a recent study published in the American Journal of Roentgenology. The imaging findings can help in further risk stratification of patients before TAVR.
The purpose of this study by Rydhwana Hossain, University of Maryland School of Medicine, Baltimore, MD, and colleagues, is to determine whether imaging features of right heart failure seen on CT performed before transcatheter aorta valve replacement (TAVR) predict poor outcomes after the procedure.
The researchers retrospectively evaluated findings on CT before TAVR for 505 patients. Of these, 300 patients underwent TAVR. Patient demographic characteristics and clinical and procedural data were recorded. Then they evaluated imaging features including signs of left heart failure, right heart failure, coronary artery disease, lung disease, and apparatus calcifications and concomitant mitral valve.
The primary outcome was all-cause mortality at 1 year after TAVR. Patients were divided into two groups -- those who were alive (group 1) and those who died by 1 year after TAVR (group 2). The comparison between these groups were made using the Pearson chi-square and Fisher exact tests and the Mann-Whitney U test.
Key findings of the study include:
- A total of 31 patients (10.3%) died within 1 year of TAVR.
- The presence and size of pericardial effusions were strongly associated with mortality within 1 year after TAVR.
- Pericardial effusion was noted in 25 patients in group 1 (9.3%) and eight patients in group 2 (25.8%).
- Increased size of the main pulmonary artery was associated with death, with a median main pulmonary artery size of 2.9 cm (interquartile range, 2.6-3.3 cm) in group 1 and 3.2 cm (interquartile range, 2.9-3.5 cm) in group 2.
- In multivariate analysis, pericardial effusion size and pulmonary artery size, both of which are indicative of right heart failure, were predictors of death, independent of the routinely used clinical Society of Thoracic Surgeons score (AUC, 0.758).
- Depressed right ventricular ejection fraction, as identified on echocardiography, was associated with mortality within 1 year after TAVR, further corroborating the CT findings.
"Features related to right heart failure on pre-TAVR CT were associated with increased all-cause mortality within the first year after TAVR, even after adjustment for the Society of Thoracic Surgeons score. Such imaging findings can help in further risk stratification of patients before TAVR," concluded the authors.
The study, "Preprocedure CT Findings of Right Heart Failure as a Predictor of Mortality After Transcatheter Aortic Valve Replacement," is published in the American Journal of Roentgenology.
DOI: https://www.ajronline.org/doi/abs/10.2214/AJR.20.22894
