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. 2020 Apr 30;2(2):e190093.
doi: 10.1148/ryct.2020190093. eCollection 2020 Apr.

Fibrotic Lung Disease at CT Predicts Adverse Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement

Cheng Ting Lin  1 , Matthew J Czarny  1 , Amira Hussien  1 , Rani K Hasan  1 , Brian T Garibaldi  1 , Elliot K Fishman  1 , Jon R Resar  1 , Stefan Loy Zimmerman  1
Affiliations

Fibrotic Lung Disease at CT Predicts Adverse Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement

Cheng Ting Lin et al. Radiol Cardiothorac Imaging. .

Abstract

Purpose: To evaluate the relationship between CT findings of diffuse lung disease and post-transcatheter aortic valve replacement (TAVR) outcomes.

Materials and methods: Retrospective review of pre-TAVR CT scans obtained during 2012-2017 was conducted. Emphysema, reticulation, and honeycombing were separately scored using a five-point scale and applied to 10 images per examination. The fibrosis score was the sum of reticulation and honeycombing scores. Lung diseases were also assessed as dichotomous variables (zero vs nonzero scores). The two outcomes evaluated were death and the composite of death and readmission.

Results: The study included 373 patients with median age of 84 years (age range, 51-98 years; interquartile range, 79-88 years) and median follow-up of 333 days. Fibrosis and emphysema were present in 66 (17.7%) and 95 (25.5%) patients, respectively. Fibrosis as a dichotomous variable was independently associated with the composite of death and readmission (hazard ratio [HR], 1.54; P = .030). In those without known chronic lung disease (CLD) (HR, 3.09; P = .024) and those without airway obstruction, defined by a ratio of forced expiratory volume in 1 second to the forced vital capacity greater than or equal to 70% (HR, 1.67, P = .039), CT evidence of fibrosis was a powerful predictor of adverse events. Neither emphysema score nor emphysema as a dichotomous variable was an independent predictor of outcome.

Conclusion: The presence of fibrosis on baseline CT scans was an independent predictor of adverse events after TAVR. In particular, fibrosis had improved predictive value in both patients without known CLD and patients without airway obstruction.Supplemental material is available for this article.© RSNA, 2020.

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Conflict of interest statement

Disclosures of Conflicts of Interest: C.T.L. disclosed no relevant relationships. M.J.C. disclosed no relevant relationships. A.H. disclosed no relevant relationships. R.K.H. disclosed no relevant relationships B.T.G. disclosed no relevant relationships. E.K.F. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: author is cofounder and shareholder in HipGraphics; institution has grants from GE as educational support to Hopkins; author receives educational support from Siemens. Other relationships: disclosed no relevant relationships. J.R.R. disclosed no relevant relationships. S.L.Z. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: institution receives salary support from Siemens Healthcare for consulting on clinical product; institution receives research grant from American Heart Association. Other relationships: disclosed no relevant relationships.

Figures

Division of chest CT data set into 10 contiguous axial slices.>
Figure 1:
Division of chest CT data set into 10 contiguous axial slices.
Scoring of reticulation on two axial CT images at different levels.
Figure 2:
Scoring of reticulation on two axial CT images at different levels.
Kaplan-Meier survival curves demonstrate the difference in (a) death and (b) death or readmission in patients with and those without fibrosis at CT and the difference in (c) death and (d) death or readmission in patients with and those without emphysema at CT.
Figure 3a:
Kaplan-Meier survival curves demonstrate the difference in (a) death and (b) death or readmission in patients with and those without fibrosis at CT and the difference in (c) death and (d) death or readmission in patients with and those without emphysema at CT.
Kaplan-Meier survival curves demonstrate the difference in (a) death and (b) death or readmission in patients with and those without fibrosis at CT and the difference in (c) death and (d) death or readmission in patients with and those without emphysema at CT.
Figure 3b:
Kaplan-Meier survival curves demonstrate the difference in (a) death and (b) death or readmission in patients with and those without fibrosis at CT and the difference in (c) death and (d) death or readmission in patients with and those without emphysema at CT.
Kaplan-Meier survival curves demonstrate the difference in (a) death and (b) death or readmission in patients with and those without fibrosis at CT and the difference in (c) death and (d) death or readmission in patients with and those without emphysema at CT.
Figure 3c:
Kaplan-Meier survival curves demonstrate the difference in (a) death and (b) death or readmission in patients with and those without fibrosis at CT and the difference in (c) death and (d) death or readmission in patients with and those without emphysema at CT.
Kaplan-Meier survival curves demonstrate the difference in (a) death and (b) death or readmission in patients with and those without fibrosis at CT and the difference in (c) death and (d) death or readmission in patients with and those without emphysema at CT.
Figure 3d:
Kaplan-Meier survival curves demonstrate the difference in (a) death and (b) death or readmission in patients with and those without fibrosis at CT and the difference in (c) death and (d) death or readmission in patients with and those without emphysema at CT.
Among individuals without chronic lung disease (CLD), Kaplan-Meier survival curve comparing the outcomes of (a) death and (b) death or readmission in patients with and those without fibrosis at CT.
Figure 4a:
Among individuals without chronic lung disease (CLD), Kaplan-Meier survival curve comparing the outcomes of (a) death and (b) death or readmission in patients with and those without fibrosis at CT.
Among individuals without chronic lung disease (CLD), Kaplan-Meier survival curve comparing the outcomes of (a) death and (b) death or readmission in patients with and those without fibrosis at CT.
Figure 4b:
Among individuals without chronic lung disease (CLD), Kaplan-Meier survival curve comparing the outcomes of (a) death and (b) death or readmission in patients with and those without fibrosis at CT.
Among individuals with forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) greater than or equal to 0.7, Kaplan-Meier survival curve comparing the outcome of death or readmission in patients with and without fibrosis at CT.
Figure 5:
Among individuals with forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) greater than or equal to 0.7, Kaplan-Meier survival curve comparing the outcome of death or readmission in patients with and without fibrosis at CT.
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