Prognostic value of coronary CTA-based AI plaque quantification in patients undergoing transcatheter aortic valve implantation

Abstract

Background: Coronary artery disease can be concomitantly evaluated as part of the pre-transcatheter aortic valve implantation (TAVI) CT angiography (CTA). More recently it has been possible to perform quantitative plaque analysis on coronary CT angiography (CCTA). In this study, we aimed to assess the prognostic value of quantitative plaque volumes using Artificial Intelligence Quantified Coronary Plaque Analysis (AI-QCPA) on pre-TAVI CTA.

Methods: This observational cohort study included patients who underwent CTA for TAVI planning with concomitant evaluation for coronary atherosclerosis. Studies were performed on a 192-slice dual-source SIEMENS Force CT scanner without administration of pre-medication such as nitroglycerin or beta-blockers. We examined coronary plaque characteristics in TAVI patients with AI-QCPA and assessed differences in plaque volumes between patients who developed major adverse cardiac events (MACE) at one year versus those who did not. MACE was defined as a composite of all-cause mortality, stroke, myocardial infarction, heart failure hospitalization, or unplanned revascularization within 1-year post-TAVI.

Results: AI-QCPA was performed in 128 patients, with mean age of 80.1 ± 9.6 years (51.6 % male). A total of 24 patients developed MACE at 1 year. Median total plaque volume (TPV), calcified plaque volume (CPV), non-calcified plaque volume (NCPV), and low-attenuation plaque volume (LAPV) were significantly higher in patients who developed MACE. Multivariable regression analysis adjusting for Society of Thoracic Surgeons (STS) score, statin use, and revascularization pre-TAVI, showed that the highest quartile of NCPV (OR 4.56, 95 % CI 1.61-12.89; p = 0.004) and LAPV (OR 3.70, 95 % CI 1.29-10.60; p = 0.015) were independently associated with MACE. When adjusted for coronary stenosis total plaque and all plaque subtypes were independently associated with MACE.

Conclusion: There is high volume of coronary plaque in patients undergoing TAVI assessed by AI-QCPA which is independently associated with the development of MACE one year post-TAVI.

Keywords: Artificial intelligence; Coronary artery disease; Coronary atherosclerosis; Multidetector Computed tomography; Transcatheter aortic valve implantation.