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CT-Determined Tricuspid Annular Dilatation Is Associated With Increased 2-Year Mortality in TAVR Patients

Simon Deseive1, Julius Steffen1, Markus Beckmann2

  • 1Medizinische Klinik und Poliklinik I, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany; German Centre for Cardiovascular Research, partner site Munich, Munich, Germany.

JACC. Cardiovascular Interventions
|October 18, 2020
PubMed

Insights

Tricuspid annular dilatation (TAD) identified via CT scans predicts mortality in severe aortic stenosis patients undergoing TAVR. This finding is independent of other clinical factors, offering a new prognostic tool.

Area of Science:

  • Cardiology
  • Radiology
  • Medical Imaging

Background:

  • Tricuspid annular dilatation (TAD) is increasingly recognized as a factor linked to adverse outcomes in valvular heart disease.
  • Accurate assessment of TAD is crucial for risk stratification in patients with cardiac conditions.

Purpose of the Study:

  • To determine the prevalence of tricuspid annular dilatation (TAD) in patients undergoing transfemoral transcatheter aortic valve replacement (TAVR).
  • To evaluate the prognostic significance of TAD, measured using multislice computed tomography (CT), on mortality in this patient cohort.

Main Methods:

  • Maximal septolateral diameter of the tricuspid annulus was measured from 3D multidetector row CT datasets in 1,137 patients undergoing transfemoral TAVR.
  • Receiver-operating characteristic (ROC) analysis identified a body surface area-normalized cutoff of 23 mm/m² for TAD.
  • All-cause mortality was assessed over a mean follow-up of 1.8 years.

Main Results:

  • Tricuspid annular dilatation (TAD) was identified in 39.2% of patients (n=446).
  • TAD did not impact procedural outcomes but was associated with significantly increased all-cause mortality (HR: 1.99).
  • Multivariate analysis confirmed TAD as an independent predictor of mortality (HR: 1.78), outperforming traditional echocardiographic parameters.

Conclusions:

  • Tricuspid annular dilatation (TAD) is an independent predictor of all-cause mortality in patients with severe aortic stenosis undergoing TAVR.
  • TAD provides incremental prognostic value beyond established clinical and echocardiographic risk models.
  • CT-derived TAD measurement offers a valuable tool for risk stratification in TAVR candidates.
Abstract

Keywords:
aortic stenosistranscatheter aortic valve replacementtricuspid annular dilatationtricuspid regurgitation

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