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Erschienen in: The International Journal of Cardiovascular Imaging 10/2017

26.05.2017 | Original Paper

Value of CT signs and measurements as a predictor of pulmonary hypertension and mortality in symptomatic severe aortic valve stenosis

verfasst von: Matthias Eberhard, Monika Mastalerz, Jovana Pavicevic, Thomas Frauenfelder, Fabian Nietlispach, Francesco Maisano, Felix C. Tanner, Thi Dan Linh Nguyen-Kim

Erschienen in: The International Journal of Cardiovascular Imaging | Ausgabe 10/2017

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Abstract

To assess the value of computed tomography (CT) for non-invasive detection of pulmonary hypertension (PH) in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) and to correlate CT measurements and signs with mortality after TAVI. 257 TAVI patients (median 84 years; 134 females) with both right heart catheterisation (RHC) and CT within 3 days were retrospectively analyzed. According to guidelines PH was defined as mean pulmonary artery pressure ≥25 mmHg in RHC. CT-signs for PH assessment were evaluated. Clinical data was recorded before and at 30 days, 1 year and 2 years after TAVI. 161 patients exhibited PH (median 83 years; 90 females). In patients with PH, main pulmonary artery diameter (MPA; p < 0.001) and anterior pericardial recess (PR; p = 0.003) were significantly larger. Furthermore, pleural effusion (p < 0.001) was significantly more common. Sensitivity and specificity for predicting PH were calculated for MPA diameter ≥29 mm (56 and 61%), PR diameter ≥10 mm (37 and 82%), and presence of pleural effusion (42 and 91%). Patients with PH showed significantly higher 2 years mortality after TAVI (30 vs. 17%; p = 0.01) with a Hazard ratio (HR) of 2.5 (95% CI 1.1–5.8; p = 0.027). Pleural effusion was a predictor of higher 2-year-all-cause mortality after TAVI (42 vs. 20%; p = 0.022) with a HR of 2.0 (95% CI 1.0–3.8; p = 0.042). Patients with symptomatic AS and PH at baseline display higher 2 year-all-cause mortality after TAVI. Several CT-signs suggest the presence of PH in TAVI patients with moderate to high specificity, but low sensitivity. Pleural effusion in CT is a predictor of higher 2 year-all-cause mortality.
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Metadaten
Titel
Value of CT signs and measurements as a predictor of pulmonary hypertension and mortality in symptomatic severe aortic valve stenosis
verfasst von
Matthias Eberhard
Monika Mastalerz
Jovana Pavicevic
Thomas Frauenfelder
Fabian Nietlispach
Francesco Maisano
Felix C. Tanner
Thi Dan Linh Nguyen-Kim
Publikationsdatum
26.05.2017
Verlag
Springer Netherlands
Erschienen in
The International Journal of Cardiovascular Imaging / Ausgabe 10/2017
Print ISSN: 1569-5794
Elektronische ISSN: 1875-8312
DOI
https://doi.org/10.1007/s10554-017-1180-5

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