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Prognostic value of cardiac computed tomography parameters to predict pre-intervention outcomes in patients with severe aortic stenosis
Session:
SESSÃO DE POSTERS 39 - IMAGEM CARDÍACA NA ESTENOSE AÓRTICA
Speaker:
ADRIANA VAZÃO
Congress:
CPC 2025
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.2 Computed Tomography
Session Type:
Cartazes
FP Number:
---
Authors:
Adriana Vazão; Mónica Amado; Carolina Gonçalves; André Martins; Joana Pereira; Mariana Carvalho; Margarida Cabral; João Carvalho; Luís Graça Santos; Hélia Martins
Abstract
<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><strong>Introduction: </strong><span style="color:black">Severe aortic stenosis (SAS) prevalence is progressively increasing and transcatheter aortic valve implantation (TAVI) is the preferred treatment option for older patients (pts). However, it is not always readily available, and pts face prolonged waiting periods. Identifying predictors of clinical decompensation during this period may help optimize patient management.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><strong>Objective: </strong><span style="color:black">To assess the predictive value of cardiac computed tomography (CCT) parameters for pre-intervention outcomes in pts awaiting TAVI. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><strong>Methods: </strong>R<span style="color:black">etrospective cohort study of SAS pts who consecutively underwent pre-TAVI CCT (June 2022-September 2024). Demographic data, clinical characteristics, transthoracic echocardiography (TTE), and CCT parameters were collected. Pts were followed from the date of the CCT until aortic valve replacement, death, or December 1, 2024, whichever occurred first (median follow-up: 8 months). Our pre-intervention endpoint was a composite of cardiovascular (CV) hospitalization - including heart failure (HF) admissions - all-cause mortality, and major adverse cardiovascular events (MACE), defined as CV mortality, non-fatal acute myocardial infarction (AMI), or non-fatal stroke. Patients with pre-intervention outcomes (group 1) were compared to those without (group 2). </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><strong>Results: </strong><span style="color:black">Overall, 189 pts underwent pre-TAVI CCT (98 males (52%); mean age 81±5 years). During the study, 79 pts (42%) underwent intervention (median time CCT-TAVI: 9 [4–14]months), while 7 were deemed unfit or declined intervention. Our pre-intervention endpoint occurred in 47 pts (25%) (group 1) with the following distribution: CV hospitalization (n=35), HF hospitalization (n=21), MACE (n=9 - non-fatal strokes [n=4], non-fatal AMIs [n=1], CV death [n=8]) and all-cause mortality (n=20). Group 1 pts were more likely to have diabetes (51vs 35%,p=0.043), atrial fibrillation (AF) (49 vs 24%,p=0.001) and pacemaker implantation (26 vs 6%,p<0.001). While most CCT parameters were similar, Group 1 had a lower estimated left ventricular ejection fraction (LVEF) (58±11% vs. 64±10%,p=0.028). Clinically, Group 1 had higher HF incidence (87% vs. 71%,p=0.028) and NYHA Class III-IV (40 vs. 23%,p=0.017). Multivariate logistic regression identified AF (OR 4.64, CI 1.7-12.9,p=0.003) and CCT-estimated LVEF (OR 0.949, CI 0.906-0.994,p=0.028) as independent predictors of our outcome. Receiver operating characteristic (ROC) analysis determined an optimal LVEF cutoff of 56.5%, which predicted the outcome with 80% sensitivity and 46% specificity (AUC 0.65, 95% CI 0.528-0.775) (Fig1).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><strong>Conclusion: </strong><span style="color:black">In our study, the incidence of adverse outcomes, namely CV hospitalization, was high in SAS<strong> </strong>pt awaiting TAVI, with median time from CCT to intervention of almost a year. Lower CCT-estimated LVEF (cutoff value of 56.5%) was a predictor of pre-intervention outcomes, with modest discriminative performance.</span></span></span></span></p>
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