The Canadian journal of cardiology · 2025
Association of Cardiac Damage and Computed Tomography-Derived Extracellular Volume in Patients Undergoing Transcatheter Aortic Valve Implantation.
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Belmonte Marta, Paolisso Pasquale, de Oliveira Elayne Kelen, Bladt Olivier, Terzi Riccardo, Mistrulli Raffaella, Corradetti Sara, Viscusi Michele, Marchetti Davide, Ratti Angelo, Schillaci Matteo, Gallinoro Emanuele, Wyffels Eric, Penicka Martin, Conte Edoardo, Barbato Emanuele, Andreini Daniele, Vanderheyden Marc
Аннотация
BACKGROUND: Extravalvular cardiac damage (EVCD) and extracellular volume (ECV) are key determinants of poor outcomes in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). We aimed to assess the association of ECV derived by means of cardiac computed tomography (CT) with EVCD before and after TAVI, its impact on left ventricular reverse remodelling, and functional improvements at 3-month follow-up in patients with severe AS undergoing TAVI.
METHODS: This was a prospective study of 73 consecutive patients undergoing TAVI, with CT-derived ECV assessment and baseline and follow-up echocardiographic evaluation of EVCD. After identifying the best ECV cutoff for predicting EVCD progression and advanced EVCD (stages 3-4) at follow-up according to the Youden index, patients were divided into low (n = 39) and high (n = 34) ECV groups. Predictors of EVCD progression, advanced EVCD, and functional improvements at follow-up were identified by means of logistic regression analysis.
RESULTS: At 3-month follow-up, 34.2% of patients showed EVCD progression. ECV ≥ 32% accurately predicted EVCD progression and stages 3-4 (area under the receiver operating characteristic curve 0.66, P < 0.001). At follow-up, patients with high ECV were more frequently in stages 3-4 (P = 0.011) and had a 50% progression rate (P = 0.012). Conversely, patients with low ECV exhibited greater LV reverse remodelling (P = 0.004) and improvement in New York Heart Association (NYHA) functional class at both 3-month (P = 0.020) and 6-month (P = 0.001) follow-ups compared with patients with high ECV. High ECV emerged as an independent predictor of EVCD progression (odds ratio [OR] 4.34, 95% CI 1.36-13.78, P = 0.013), stages 3-4 (OR 5.71, 95% CI 1.77-18.42, P = 0.004) and lack of improvement in NYHA functional class (OR 3.22, 95% CI 1.14-9.09, P = 0.027) at 3-month follow-up.
CONCLUSIONS: Elevated CT-derived ECV was associated with EVCD progression and reduced functional improvement after TAVI.
METHODS: This was a prospective study of 73 consecutive patients undergoing TAVI, with CT-derived ECV assessment and baseline and follow-up echocardiographic evaluation of EVCD. After identifying the best ECV cutoff for predicting EVCD progression and advanced EVCD (stages 3-4) at follow-up according to the Youden index, patients were divided into low (n = 39) and high (n = 34) ECV groups. Predictors of EVCD progression, advanced EVCD, and functional improvements at follow-up were identified by means of logistic regression analysis.
RESULTS: At 3-month follow-up, 34.2% of patients showed EVCD progression. ECV ≥ 32% accurately predicted EVCD progression and stages 3-4 (area under the receiver operating characteristic curve 0.66, P < 0.001). At follow-up, patients with high ECV were more frequently in stages 3-4 (P = 0.011) and had a 50% progression rate (P = 0.012). Conversely, patients with low ECV exhibited greater LV reverse remodelling (P = 0.004) and improvement in New York Heart Association (NYHA) functional class at both 3-month (P = 0.020) and 6-month (P = 0.001) follow-ups compared with patients with high ECV. High ECV emerged as an independent predictor of EVCD progression (odds ratio [OR] 4.34, 95% CI 1.36-13.78, P = 0.013), stages 3-4 (OR 5.71, 95% CI 1.77-18.42, P = 0.004) and lack of improvement in NYHA functional class (OR 3.22, 95% CI 1.14-9.09, P = 0.027) at 3-month follow-up.
CONCLUSIONS: Elevated CT-derived ECV was associated with EVCD progression and reduced functional improvement after TAVI.