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Prognostic impact of identifying etiology of prosthetic valve dysfunction with CT
Gurmandeep S Sandhu1, Pratik S Velangi2, Harmeet Kharoud3
1Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
Insights
Computed tomography (CT) evaluation of prosthetic valve degeneration (PVD) shows prognostic value for adverse outcomes in patients with prosthetic heart valves. CT assessment of structural valve degeneration (SVD) is significant for predicting reoperation and mortality.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Prosthetic heart valve (PHV) dysfunction (PVD) requires etiology-specific treatment.
- Computed tomography (CT) is increasingly used in PHV evaluation.
- The prognostic value of CT for PVD etiology is not well-established.
Purpose of the Study:
- To investigate the prognostic value of CT-determined PVD etiology for adverse clinical outcomes.
- To compare the prognostic significance of CT versus echocardiography for PVD.
- To assess the association of CT findings with reoperation and all-cause mortality.
Main Methods:
- Retrospective analysis of patients with suspected PVD undergoing CT and echocardiography.
- CT and echocardiography assessed for pannus, structural valve degeneration (SVD), and thrombus.
- Kaplan-Meier and Cox regression analyses used to evaluate outcomes.
Main Results:
- CT diagnosed PVD etiology in 60.6% of patients, echocardiography in 34.1%.
- CT-diagnosed SVD was a significant univariate predictor of adverse outcomes.
- Multivariable analysis showed CT-diagnosed SVD (HR: 1.79) was significantly associated with adverse outcomes, while echocardiography-diagnosed SVD was not.
Conclusions:
- CT assessment of SVD in patients with suspected PVD has prognostic significance for adverse outcomes.
- CT should be considered in the diagnostic workup of patients with suspected PVD.
- CT offers valuable prognostic information beyond echocardiography for PVD.
Background:
In patients with prosthetic heart valves (PHV), there are distinct treatment implications based on prosthetic valve dysfunction (PVD) etiology. We investigated whether evaluation for PVD etiology on computed tomography (CT) has prognostic value for adverse clinical outcomes.
Methods:
Consecutive patients with suspected PVD that had a clinically indicated contrast chest CT and echocardiogram done within 1 year of each other were identified retrospectively from the Prosthetic Heart Valve CT Registry at the University of Minnesota. CTs and echocardiograms were assessed for potential PVD etiologies of pannus, structural valve degeneration (SVD) and thrombus, as per standard guidelines. Kaplan-Meier and Cox regression analyses were performed to assess association with a composite outcome of reoperation and all-cause mortality.
Results:
132 patients (51.5% male, mean age 62.1 ± 19.3 years) with suspected PVD were included. There were 97 tissue valves, 31 mechanical valves and 4 transcatheter valves. The location of the valve was as follows: 72 aortic, 45 mitral, 8 tricuspid, and 7 pulmonic. A PVD etiology was diagnosed on CT in 80 (60.6%) patients, and on echocardiography in 45 (34.1%) patients, largely driven by a diagnosis of SVD on both modalities. Significant univariate predictors of the composite outcome included CT diagnosis of SVD (P < 0.001), echocardiography diagnosis of SVD (P < 0.001), degree of prosthetic stenosis (P < 0.001) and degree of prosthetic regurgitation (P < 0.001). On multivariable analyses adjusted for age, sex, left ventricular function, degree of prosthetic stenosis and degree of prosthetic regurgitation, CT diagnosis of SVD was significantly associated with the composite outcome (HR: 1.79, 1.09-2.95) whereas echocardiography diagnosis of SVD was not (HR: 1.56, 0.98-2.46).
Conclusion:
In patients with suspected PVD, CT assessment of SVD had prognostic significance for hard outcomes. CT should be considered in the diagnostic evaluation of patients with suspected PVD.
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