Feasibility of Coronary CT Angiography-derived Left Ventricular Long-Axis Shortening as an Early Marker of Ventricular Dysfunction in Transcatheter Aortic Valve Replacement

Gilberto J Aquino; Josua A Decker; U Joseph Schoepf; Landin Carson; Namrata Paladugu; Basel Yacoub; Verena Brandt; Anna Lena Emrich; Florian Schwarz; Jeremy R Burt; Richard Bayer 2nd; Akos Varga-Szemes; Tilman Emrich

doi:10.1148/ryct.210205

Feasibility of Coronary CT Angiography-derived Left Ventricular Long-Axis Shortening as an Early Marker of Ventricular Dysfunction in Transcatheter Aortic Valve Replacement

Radiol Cardiothorac Imaging. 2022 Jun 30;4(3):e210205. doi: 10.1148/ryct.210205. eCollection 2022 Jun.

Affiliation

¹ Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.).

^# Contributed equally.

Abstract

Purpose: To evaluate the value of using left ventricular (LV) long-axis shortening (LAS) derived from coronary CT angiography (CCTA) to predict mortality in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).

Materials and methods: Patients with severe AS who underwent CCTA for preprocedural TAVR planning between September 2014 and December 2019 were included in this retrospective study. CCTA covered the whole cardiac cycle in 10% increments. Image series reconstructed at end systole and end diastole were used to measure LV-LAS. All-cause mortality within 24 months of follow-up after TAVR was recorded. Cox regression analysis was performed, and hazard ratios (HRs) are presented with 95% CIs. The C index was used to evaluate model performance, and the likelihood ratio χ² test was performed to compare nested models.

Results: The study included 175 patients (median age, 79 years [IQR, 73-85 years]; 92 men). The mortality rate was 22% (38 of 175). When adjusting for predictive clinical confounders, it was found that LV-LAS could be used independently to predict mortality (adjusted HR, 2.83 [95% CI: 1.13, 7.07]; P = .03). In another model using the Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM), LV-LAS remained significant (adjusted HR, 3.38 [95 CI: 1.48, 7.72]; P = .004), and its use improved the predictive value of the STS-PROM, increasing the STS-PROM C index from 0.64 to 0.71 (χ² = 29.9 vs 19.7, P = .001). In a subanalysis of patients with a normal LV ejection fraction (LVEF), the significance of LV-LAS persisted (adjusted HR, 3.98 [95 CI: 1.56, 10.17]; P = .004).

Conclusion: LV-LAS can be used independently to predict mortality in patients undergoing TAVR, including those with a normal LVEF.Keywords: CT Angiography, Transcatheter Aortic Valve Implantation/Replacement (TAVI/TAVR), Cardiac, Outcomes Analysis, Cardiomyopathies, Left Ventricle, Aortic Valve Supplemental material is available for this article. © RSNA, 2022See also the commentary by Everett and Leipsic in this issue.

Keywords: Aortic Valve; CT Angiography; Cardiac; Cardiomyopathies; Left Ventricle; Outcomes Analysis; Transcatheter Aortic Valve Implantation/Replacement (TAVI/TAVR).