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

  • Cardiac
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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.

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Abbreviations

BSA:

Body surface area

CVP:

Central venous pressure

IVC:

Inferior vena cava

PCWP:

Pulmonary capillary wedge pressure

RHC:

Right heart catheterisation

TAVI:

Transcatheter aortic valve implantation

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Acknowledgements

We thank Gillian von Rechenberg for language and punctuation revision of our manuscript.

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistr. 100, 8091, Zurich, Switzerland

    Matthias Eberhard, Michael Ho, Thomas Frauenfelder & Thi Dan Linh Nguyen-Kim

  2. Division of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy

    Gianluca Milanese

  3. University Heart Centre Zurich, Zurich, Switzerland

    Stefan Zimmermann, Fabian Nietlispach, Francesco Maisano & Felix C. Tanner

Authors
  1. Matthias Eberhard
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  2. Gianluca Milanese
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  3. Michael Ho
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  4. Stefan Zimmermann
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  5. Thomas Frauenfelder
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  6. Fabian Nietlispach
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  7. Francesco Maisano
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  8. Felix C. Tanner
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  9. Thi Dan Linh Nguyen-Kim
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Corresponding author

Correspondence to Matthias Eberhard.

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Guarantor

The scientific guarantor of this publication is Thi Dan Linh Nguyen-Kim.

Conflict of interest

The authors of this manuscript declare relationships with the following companies:

Francesco Maisano is consultant for Abbott Vascular, St Jude Medical, Medtronic, ValtechCardio and receives royalties from Edwards Lifesciences.

Fabian Nietlispach is consultant for Edwards Lifesciences, Medtronic, St Jude Medical.

Thi Dan Linh Nguyen-Kim is funded by the research grant “Filling the gap” from the University of Zurich, Switzerland.

All other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in:

1. Eberhard M, Mastalerz M, Frauenfelder T et al (2017) Quantification of aortic valve calcification on contrast-enhanced CT of patients prior to transcatheter aortic valve implantation. EuroIntervention 13:921-927

2. Eberhard M, Mastalerz M, Pavicevic J et al (2017) Value of CT signs and measurements as a predictor of pulmonary hypertension and mortality in symptomatic severe aortic valve stenosis. Int J Cardiovasc Imaging 33:1637-1651

3. Possner M, Vontobel J, Nguyen-Kim TD et al (2016) Prognostic value of aortic regurgitation after AVI in patients with chronic kidney disease. Int J Cardiol 221:180-187

4. Stahli BE, Abouelnour A, Nguyen TD et al (2014) Impact of three-dimensional imaging and pressure recovery on echocardiographic evaluation of severe aortic stenosis: a pilot study. Echocardiography 31:1006-1016

While the previous studies assessed quantification of aortic valve calcification, prognostic value of aortic regurgitation after TAVI, impact of three-dimensional imaging and pressure recovery on echocardiographic evaluation of severe aortic stenosis and value of previously reported CT signs and measurements as a predictor of pulmonary hypertension and mortality in severe aortic stenosis, this work focused on whether IVC measurements are correlated with central venous pressure and the predictive value of IVC measurements on one-year mortality after TAVI. Thus, this work is substantially different from the previous reports. Additionally, in contrast to the aforementioned studies the present study is the only one including all patients undergoing TAVI between 01/2011 and 12/2014 at our institution.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Eberhard, M., Milanese, G., Ho, M. et al. Pre-procedural CT angiography inferior vena cava measurements: a predictor of mortality in patients undergoing transcatheter aortic valve implantation. Eur Radiol 29, 975–984 (2019). https://doi.org/10.1007/s00330-018-5613-x

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  • DOI: https://doi.org/10.1007/s00330-018-5613-x

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