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Prognostic implications of cardiac damage classification based on computed tomography in severe aortic stenosis

Kensuke Hirasawa1, Philippe J vanRosendael1, Federico Fortuni1,2

  • 1Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands.

European Heart Journal. Cardiovascular Imaging
|April 15, 2021
PubMed

Insights

A new Multidetector Row Computed Tomography (MDCT) staging system for severe aortic stenosis (AS) identifies patients at higher risk of death after transcatheter aortic valve implantation (TAVI). This system assesses extra-valvular cardiac damage to improve patient stratification and outcomes.

Area of Science:

  • Cardiology
  • Radiology
  • Medical Imaging

Background:

  • Severe aortic stenosis (AS) management often involves transcatheter aortic valve implantation (TAVI).
  • Prognosis after TAVI can be influenced by extra-valvular cardiac damage.
  • Echocardiography has established staging systems for AS prognosis, but MDCT offers detailed anatomical assessment.

Purpose of the Study:

  • To evaluate the prognostic implications of a Multidetector Row Computed Tomography (MDCT) staging system for severe AS.
  • To assess the ability of MDCT to detect and classify extra-valvular cardiac damage in AS patients undergoing TAVI.
  • To determine if this MDCT staging system can identify patients at higher risk of mortality post-TAVI.

Main Methods:

  • A cohort of 405 patients undergoing pre-TAVI MDCT for severe AS was analyzed.
  • Cardiac damage was assessed using MDCT and categorized into five stages (0-4) based on the extent of extra-valvular involvement.
  • Patient outcomes, including all-cause mortality, were tracked over a median follow-up of 3.7 years.

Main Results:

  • The study included 405 patients (80±7 years, 52% male).
  • Patients were classified into MDCT stages: Stage 0 (7%), Stage 1 (24%), Stage 2 (38%), Stage 3 (19%), and Stage 4 (13%).
  • Multivariable analysis revealed that Stage 3 (HR 4.496, P=0.039) and Stage 4 (HR 5.565, P=0.020) cardiac damage were independently associated with increased all-cause mortality post-TAVI.

Conclusions:

  • The MDCT-based staging system for cardiac damage in severe AS is effective in identifying patients with a higher risk of mortality after TAVI.
  • This imaging-based approach provides valuable prognostic information beyond traditional AS assessment.
  • MDCT staging can aid in risk stratification and personalized treatment planning for TAVI candidates.
Abstract

Keywords:
aortic stenosisextra-aortic valvular cardiac damagemultidetector computed tomography

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