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. 2023 Dec;30(12):2825-2833.
doi: 10.1016/j.acra.2023.03.014. Epub 2023 May 4.

Reduced Pulmonary Artery Distensibility Predicts Persistent Pulmonary Hypertension and 2-Year Mortality in Patients with Severe Aortic Stenosis Undergoing TAVR

Valery Turner  1 , Eva Maret  2 , Juyong B Kim  3 , Marina Codari  4 , Virginia Hinostroza  4 , Domenico Mastrodicasa  5 , A Claire Watkins  6 , William F Fearon  7 , Michael P Fischbein  7 , Francois Haddad  3 , Martin J Willemink  4 , Dominik Fleischmann  8
Affiliations

Reduced Pulmonary Artery Distensibility Predicts Persistent Pulmonary Hypertension and 2-Year Mortality in Patients with Severe Aortic Stenosis Undergoing TAVR

Valery Turner et al. Acad Radiol. 2023 Dec.

Abstract

Rationale and objectives: Post-TAVR persistent pulmonary hypertension (PH) is a better predictor of poor outcome than pre-TAVR PH. In this longitudinal study we sought to evaluate whether pulmonary artery (distensibility (DPA) measured on preprocedural ECG-gated CTA is associated with persistent-PH and 2-year mortality after TAVR.

Materials and methods: Three hundred and thirty-six patients undergoing TAVR between July 2012 and March 2016 were retrospectively included and followed for all-cause mortality until November 2017. All patients underwent retrospectively ECG-gated CTA prior to TAVR. Main pulmonary artery (MPA) area was measured in systole and in diastole. DPA was calculated as: [(area-MPAmax-area-MPAmin)/area-MPAmax]%. ROC analysis was performed to assess the AUC for persistent-PH. Youden Index was used to determine the optimal threshold of DPA for persistent-PH. Two groups were compared based on a DPA threshold of 8% (specificity of 70% for persistent-PH). Kaplan-Meier, Cox proportional-hazard, and logistic regression analyses were performed. The primary clinical endpoint was defined as persistent-PH post-TAVR. The secondary endpoint was defined as all-cause mortality 2 years after TAVR.

Results: Median follow-up time was 413 (interquartiles 339-757) days. A total of 183 (54%) had persistent-PH and 68 (20%) patients died within 2-years after TAVR. Patients with DPA<8% had significantly more persistent-PH (67% vs 47%, p<0.001) and 2-year deaths (28% vs 15%, p=0.006), compared to patients with DPA>8%. Adjusted multivariable regression analyses showed that DPA<8% was independently associated with persistent-PH (OR 2.10 [95%-CI 1.3-4.5], p=0.007) and 2-year mortality (HR 2.91 [95%-CI 1.5-5.8], p=0.002). Kaplan-Meier analysis showed that 2-year mortality of patients with DPA<8% was significantly higher compared to patients with DPA≥8% (mortality 28% vs 15%; log-rank p=0.003).

Conclusion: DPA on preprocedural CTA is independently associated with persistent-PH and two-year mortality in patients who undergo TAVR.

Keywords: Computed tomography angiography; Pulmonary artery; Pulmonary hypertension; Transcatheter aortic valve replacement.

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Conflict of interest statement

Declaration of Competing Interest None.

Figures

Figure 1.
Figure 1.
Representation of typical regions where the main pulmonary artery area measurements were performed. The image above represents the typical region where the area of the main pulmonary artery area was measured on double-oblique reformations. a and b show the main pulmonary artery area measured at 20% of the R-R interval. c and d show the main pulmonary artery area measured at 80% of the R-R interval. DPA for this patient was 21% (calculated as follows: DPA=[4.79cm2−3.79cm2]/4.79cm2). White * is indicating the main pulmonary artery. DPA, pulmonary artery distensibility; MPA, main pulmonary artery. (Color version of figure is available online.)
Figure 2.
Figure 2.
Kaplan-Meier analysis of 2-year survival in patients with DPA8% and <8%. Numbers at the bottom indicate the number of patients at risk and the number of events every 180 days of follow-up. DPA, Pulmonary artery distensibility. A significant difference in survival was found between patients with DPA<8% and DPA≥8% (log-rank p=0.003). DPA, pulmonary artery distensibility.
See this image and copyright information in PMC

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