Quantitative imaging in medicine and surgery · 2026
Cardiac computed tomography-derived left atrial volume index as a predictor of major adverse cardiovascular events after transcatheter aortic valve replacement.
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Li Jiaming, Shu Jun, Zhang Jin, Zhao Yao, Yang Jian, Zhao Hongliang, Zheng Minwen
Аннотация
BACKGROUND: Left atrial volume index (LAVI) has been recognized as a significant indicator of left heart remodeling and diastolic dysfunction. This study aimed to investigate the association between LAVI assessed by coronary computed tomography angiography (CCTA) and major adverse cardiovascular events (MACEs) in patients with severe aortic stenosis (AS) after transcatheter aortic valve replacement (TAVR).
METHODS: This retrospective single-center study enrolled patients with severe AS undergoing TAVR between February 2020 and June 2024. All patients underwent CCTA examination prior to TAVR. Left atrial (LA) volume was automatically quantified from CCTA images, and the LAVI was computed by indexing to body surface area (BSA). Univariate and Firth-penalized Cox proportional hazards regression analyses were used to determine the predictors of MACE. Additionally, restricted cubic spline analysis was performed to explore the relationship between LAVI and MACE.
RESULTS: A total of 206 patients (113 males, 93 females; mean age 68.11±8.01 years) were included in the final analysis. The incidence of MACE was 13.1% over a median follow-up time of 581 [interquartile range (IQR), 378-990] days. The LAVI was significantly higher in patients with MACE than in those without MACE [70.14 (54.81-84.12) vs. 51.19 (39.67-64.45) mL/m2, P<0.001]. After adjustment for clinical confounders and European System for Cardiac Operative Risk Evaluation (EuroSCORE II), LAVI ≥53.32 mL/m2 [hazard ratio (HR) =4.249, 95% confidence interval (CI): 1.585-11.394, P=0.001] and male sex (HR =2.864, 95% CI: 1.164-7.051, P=0.012) still independently predicted MACE. Restricted cubic spline results showed a nonlinear relationship between LAVI and MACE (P for nonlinearity =0.032).
CONCLUSIONS: Preprocedural CCTA-derived LAVI may aid risk stratification for MACE after TAVR in severe AS. Male patients warrant closer postprocedural attention.
METHODS: This retrospective single-center study enrolled patients with severe AS undergoing TAVR between February 2020 and June 2024. All patients underwent CCTA examination prior to TAVR. Left atrial (LA) volume was automatically quantified from CCTA images, and the LAVI was computed by indexing to body surface area (BSA). Univariate and Firth-penalized Cox proportional hazards regression analyses were used to determine the predictors of MACE. Additionally, restricted cubic spline analysis was performed to explore the relationship between LAVI and MACE.
RESULTS: A total of 206 patients (113 males, 93 females; mean age 68.11±8.01 years) were included in the final analysis. The incidence of MACE was 13.1% over a median follow-up time of 581 [interquartile range (IQR), 378-990] days. The LAVI was significantly higher in patients with MACE than in those without MACE [70.14 (54.81-84.12) vs. 51.19 (39.67-64.45) mL/m2, P<0.001]. After adjustment for clinical confounders and European System for Cardiac Operative Risk Evaluation (EuroSCORE II), LAVI ≥53.32 mL/m2 [hazard ratio (HR) =4.249, 95% confidence interval (CI): 1.585-11.394, P=0.001] and male sex (HR =2.864, 95% CI: 1.164-7.051, P=0.012) still independently predicted MACE. Restricted cubic spline results showed a nonlinear relationship between LAVI and MACE (P for nonlinearity =0.032).
CONCLUSIONS: Preprocedural CCTA-derived LAVI may aid risk stratification for MACE after TAVR in severe AS. Male patients warrant closer postprocedural attention.