Pre-procedural CT angiography inferior vena cava measurements: a predictor of mortality in patients undergoing transcatheter aortic valve implantation

Eur Radiol. 2019 Feb;29(2):975-984. doi: 10.1007/s00330-018-5613-x. Epub 2018 Jul 17.

Abstract

Objectives: To assess the value of pre-procedural computed tomography angiography (CTA) measurements of the suprahepatic inferior vena cava (IVC) to detect elevated central venous pressure (CVP) assessed by right heart catheterisation (RHC), and to predict post-procedural 1-year mortality in a cohort of patients undergoing transcatheter aortic valve implantation (TAVI).

Methods: We retrospectively evaluated 408 consecutive patients undergoing CTA before TAVI between January 2011 and December 2014. Two hundred and five patients were included in the RHC cohort, who underwent RHC and CTA within ≤1 day prior to TAVI. Two hundred and three patients not fulfilling this requirement were included in the validation cohort. Measurements of the IVC were performed between diaphragm and right atrium on axial slices. Receiver operating characteristic (ROC) analyses, Kaplan-Meier analyses and Cox regression analyses were performed.

Results: In the RHC cohort, ROC curve analyses for IVC area measurements indicated an AUC of 0.77 (p < 0.001) to detect CVP ≥10mmHg and an area under the ROC curve (AUC) of 0.72 (p < 0.001) to predict 1-year mortality. An IVC area cut-off of ≥665 mm2 predicted 1-year mortality with a specificity of 84% and a sensitivity of 63%. Kaplan-Meier analysis showed that patients with an IVC area ≥665 mm2 had a significantly higher post-procedural 1-year mortality (38% versus 7%, log-rank p < 0.001) with a hazard ratio of 5.5 (95% CI, 2.2-13.6; p < 0.001). Applying this cut-off value to the validation cohort confirmed a significantly higher 1-year mortality after TAVI (34% versus 11%; log-rank p = 0.004) for patients with an IVC area ≥665 mm2.

Conclusions: Pre-procedural enlargement of the suprahepatic IVC is a predictor of post-procedural 1-year mortality in patients evaluated for TAVI.

Key points: • IVC measurements are moderate predictors of an elevated CVP in TAVI patients. • Pre-procedural IVC enlargement is a predictor of 1-year mortality after TAVI. • IVC enlargement is associated with right heart dysfunction in TAVI patients.

Keywords: Aortic valve stenosis; Central venous pressure; Computed tomography angiography; Transcatheter aortic valve replacement; Vena cava; inferior.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve / surgery
  • Aortic Valve Stenosis / diagnostic imaging
  • Aortic Valve Stenosis / pathology
  • Aortic Valve Stenosis / physiopathology
  • Aortic Valve Stenosis / surgery*
  • Cardiac Catheterization / methods
  • Central Venous Pressure
  • Computed Tomography Angiography / methods
  • Female
  • Fluoroscopy
  • Heart Valve Prosthesis
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Preoperative Care / methods
  • Prognosis
  • Proportional Hazards Models
  • ROC Curve
  • Registries
  • Retrospective Studies
  • Sensitivity and Specificity
  • Time Factors
  • Transcatheter Aortic Valve Replacement / methods*
  • Vena Cava, Inferior / diagnostic imaging*
  • Vena Cava, Inferior / pathology
  • Vena Cava, Inferior / physiopathology