Impact of Perivascular Adipose Tissue Attenuation Around the Aortic Valve on Clinical Outcomes After Transcatheter Aortic Valve Replacement

Perivascular adipose tissue (PVAT) attenuation interacts with local and systemic vascular inflammation and consequently contributes to unfavorable clinical outcomes in patients with various cardiovascular diseases.

We retrospectively analyzed consecutive patients with severe aortic stenosis to investigate the association between PVAT attenuation measured before transcatheter aortic valve replacement (TAVR) and subsequent clinical outcomes. PVAT attenuation was measured using computed tomography angiography images around the aortic valve. The primary outcome was defined as major adverse cardiovascular events (MACE), a composite of all-cause death, stroke, and heart failure rehospitalization.

MACE was observed in 23.6% of 233 patients during a median follow-up of 2.2 years. The MACE group had significantly higher PVAT attenuation than the non-MACE group (-74.0±9.8 Hounsfield unit [HU] versus -78.9±9.2 HU, P=0.001). In the Cox regression model, higher PVAT attenuation was independently associated with MACE (hazard ratio: 1.52 [95% CI: 1.13-2.04], P=0.006). Incorporating PVAT attenuation into established prognostic factors following TAVR improved the predictive and reclassification performance of MACE risk.

Elevated PVAT attenuation around the aortic valve was associated with MACE in patients undergoing TAVR. Measuring PVAT attenuation before TAVR can help identify patients at higher risk of developing heart failure or cardiovascular death after TAVR, thereby aiding in treatment strategy decisions.

URL: https://www.umin.ac.jp/ctr/; Unique Identifier: UMIN000057107.