CT-Determined Tricuspid Annular Dilatation Is Associated With Increased 2-Year Mortality in TAVR Patients

Deseive, Simon; Steffen, Julius; Beckmann, Markus; Jochheim, David; Orban, Mathias; Zadrozny, Magda; Gschwendtner, Sarah; Braun, Daniel; Rizas, Konstantinos; Curta, Adrian; Hagl, Christian; Theiss, Hans D.; Mehilli, Julinda; Massberg, Steffen und Hausleiter, Jörg (2020): CT-Determined Tricuspid Annular Dilatation Is Associated With Increased 2-Year Mortality in TAVR Patients. In: Jacc-Cardiovascular Interventions, Bd. 13, Nr. 21: S. 2497-2507

Abstract

OBJECTIVES The aim of this study was to investigate the prevalence and prognostic impact of tricuspid annular dilatation (TAD) measured in multislice computed tomography datasets in patients undergoing transfemoral transcatheter aortic valve replacement for severe aortic stenosis. Background: TAD is an increasingly recognized entity associated with poor outcomes in patients with valvular heart disease. METHODS The maximal septolateral diameter of the tricuspid annulus was measured in consecutive patients with 3-dimensional multidetector row computed tomographic datasets undergoing transfemoral transcatheter aortic valve replacement. Receiver-operating curve characteristic analysis was performed to obtain an ideal, body surface areanormalized cutoff for TAD. Ethical approval was obtained from the institutional ethics board. RESULTS The study included 1,137 patients, of whom 299 died within a mean follow-up period of 1.8 +/- 1.0 years. TAD was identified in 446 patients (39.2%) on the basis of a receiver-operating characteristic cutoff of 23 mm/m(2). TAD had no impact on procedural outcomes, including device failure defined according to Valve Academic Research Consortium-2 criteria. Patients with TAD experienced significantly greater mortality (hazard ratio: 1.99;95% confidence interval: 1.59 to 2.51;p < 0.001). Multivariate analysis including clinical and echocardiographic parameters confirmed the predictive value of TAD (hazard ratio: 1.78;95% confidence interval: 1.33 to 2.38;p < 0.001), while echocardiographic variables, including estimated pulmonary artery pressure and the severity of tricuspid regurgitation, did not reach statistical significance. The predictive value of TAD was incremental to a baseline model of clinical and echocardiographic parameters (continuous net reclassification improvement 0.204;p < 0.01) and incremental to the Society of Thoracic Surgeons score (continuous net reclassification improvement 0.209;p < 0.001). CONCLUSIONS TAD is an independent predictor of all-cause mortality in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. (C) 2020 by the American College of Cardiology Foundation.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 1936-8798
• Sprache: Englisch