Computed tomography-based pericoronary adipose tissue attenuation in patients undergoing TAVR: a novel method for
Alexandra Steyer1,2, Silvia Mas-Peiro3,4,5, David M Leistner3
1Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany.
Insights
Pericoronary adipose tissue (PCAT) attenuation surrounding the right coronary artery (RCA) is a novel marker for predicting major adverse cardiovascular events (MACE) in patients undergoing transcatheter aortic valve replacement (TAVR). Higher RCA PCAT attenuation indicates increased risk for MACE post-TAVR.
Area of Science:
- Cardiology
- Radiology
- Biomedical Engineering
Background:
- Coronary artery disease (CAD) is prevalent in patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).
- Predictive markers for adverse outcomes post-TAVR are needed, as current screening and treatment approaches remain debated.
- Pericoronary adipose tissue (PCAT) attenuation, particularly around the proximal right coronary artery (RCA), is an emerging computed tomography (CT)-based marker for coronary inflammation.
Purpose of the Study:
- To assess the predictive value of RCA PCAT attenuation for major adverse cardiovascular events (MACE) in patients with AS undergoing TAVR.
- To compare the efficacy of RCA PCAT attenuation with conventional CAD diagnostic tools in identifying high-risk patients.
Main Methods:
- A single-center retrospective study included 62 patients undergoing TAVR.
- Conventional CAD diagnostic tools (coronary artery calcium score, stenosis assessment) and RCA PCAT attenuation were measured using CT scans.
- The association between RCA PCAT attenuation and MACE over a 24-month follow-up was analyzed using multivariate Cox regression.
Main Results:
- Fifteen patients (24.2%) experienced MACE, including 10 cardiovascular deaths.
- Mean RCA PCAT attenuation was significantly higher in patients with MACE compared to those without (-69.8 ± 7.5 vs. -74.6 ± 6.2, P=0.02).
- High RCA PCAT attenuation (> -70.5 HU) identified patients at significantly greater risk for MACE (HR: 3.82, P=0.011) and was the sole significant predictor in multivariate analysis.
Conclusions:
- RCA PCAT attenuation is a valuable CT-based marker for predicting MACE in patients with AS undergoing TAVR.
- This marker demonstrates superior reliability over conventional CAD diagnostic tools in identifying high-risk individuals.
- RCA PCAT attenuation holds significant predictive value, even in the presence of concomitant AS.
Objectives:
This study aims to assess the attenuation of pericoronary adipose tissue (PCAT) surrounding the proximal right coronary artery (RCA) in patients with aortic stenosis (AS) and undergoing transcatheter aortic valve replacement (TAVR). RCA PCAT attenuation is a novel computed tomography (CT)-based marker for evaluating coronary inflammation. Coronary artery disease (CAD) in TAVR patients is common and usually evaluated prior to intervention. The most sensible screening method and consequential treatment approach are unclear and remain a matter of ceaseless discussion. Thus, interest remains for safe and low-demand predictive markers to identify patients at risk for adverse outcomes postaortic valve replacement.
Methods:
This single-center retrospective study included patients receiving a standard planning CT scan prior to TAVR. Conventional CAD diagnostic tools, such as coronary artery calcium score and significant stenosis via invasive coronary angiography and coronary computed tomography angiography, were determined in addition to RCA PCAT attenuation using semiautomated software. These were assessed for their relationship with major adverse cardiovascular events (MACE) during a 24-month follow-up period.
Results:
From a total of 62 patients (mean age: 82 ± 6.7 years), 15 (24.2%) patients experienced an event within the observation period, 10 of which were attributed to cardiovascular death. The mean RCA PCAT attenuation was higher in patients enduring MACE than that in those without an endpoint (-69.8 ± 7.5 vs. -74.6 ± 6.2, P = 0.02). Using a predefined cutoff of >-70.5 HU, 20 patients (32.3%) with high RCA PCAT attenuation were identified, nine (45%) of which met the endpoint within 2 years after TAVR. In a multivariate Cox regression model including conventional CAD diagnostic tools, RCA PCAT attenuation prevailed as the only marker with significant association with MACE (P = 0.02). After dichotomization of patients into high- and low-RCA PCAT attenuation groups, high attenuation was related to greater risk of MACE (hazard ration: 3.82, P = 0.011).
Conclusion:
RCA PCAT attenuation appears to have predictive value also in a setting of concomitant AS in patients receiving TAVR. RCA PCAT attenuation was more reliable than conventional CAD diagnostic tools in identifying patients at risk for MACE .
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