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

  • Matthias Eberhard
  • Monika Mastalerz
  • Jovana Pavicevic
  • Thomas Frauenfelder
  • Fabian Nietlispach
  • Francesco Maisano
  • Felix C. Tanner
  • Thi Dan Linh Nguyen-Kim
Original Paper

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.

Keywords

Aortic stenosis Multislice computed tomography Pleural effusion Pulmonary artery diameter Pulmonary hypertension Transcatheter aortic valve implantation 

Notes

Funding

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

Compliance with ethical standards

Conflict of interest

Francesco Maisano is cofounder of 4Tech, 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. All other authors have no conflicts of interest to declare.

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Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  • Matthias Eberhard
    • 1
    • 3
  • Monika Mastalerz
    • 1
  • Jovana Pavicevic
    • 2
  • Thomas Frauenfelder
    • 1
  • Fabian Nietlispach
    • 2
  • Francesco Maisano
    • 2
  • Felix C. Tanner
    • 2
  • Thi Dan Linh Nguyen-Kim
    • 1
  1. 1.Department of Diagnostic and Interventional RadiologyUniversity Hospital ZurichZurichSwitzerland
  2. 2.University Heart Center ZurichZurichSwitzerland
  3. 3.Department of Diagnostic and Interventional RadiologyUniversity Hospital ZurichZurichSwitzerland

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