Computed tomography–based pericoronary adipose tissue attenuation in patients undergoing TAVR: a novel method for risk assessment
ObjectivesThis study aims to assess the attenuation of pericoronary adipose tissue (PCAT) surrounding the proximal right coronary artery (RCA) in patients with aortic stenosis (AS) and undergoing transcatheter aortic valve replacement (TAVR). RCA PCAT attenuation is a novel computed tomography (CT)–...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-05-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1192093/full |
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| author | Alexandra Steyer Alexandra Steyer Silvia Mas-Peiro Silvia Mas-Peiro Silvia Mas-Peiro David M. Leistner Valentina O. Puntmann Eike Nagel Eike Nagel Damini Dey Markus Goeller Vitali Koch Vitali Koch Christian Booz Thomas J. Vogl Simon S. Martin Simon S. Martin |
| author_facet | Alexandra Steyer Alexandra Steyer Silvia Mas-Peiro Silvia Mas-Peiro Silvia Mas-Peiro David M. Leistner Valentina O. Puntmann Eike Nagel Eike Nagel Damini Dey Markus Goeller Vitali Koch Vitali Koch Christian Booz Thomas J. Vogl Simon S. Martin Simon S. Martin |
| author_sort | Alexandra Steyer |
| collection | DOAJ |
| description | ObjectivesThis study aims to assess the attenuation of pericoronary adipose tissue (PCAT) surrounding the proximal right coronary artery (RCA) in patients with aortic stenosis (AS) and undergoing transcatheter aortic valve replacement (TAVR). RCA PCAT attenuation is a novel computed tomography (CT)–based marker for evaluating coronary inflammation. Coronary artery disease (CAD) in TAVR patients is common and usually evaluated prior to intervention. The most sensible screening method and consequential treatment approach are unclear and remain a matter of ceaseless discussion. Thus, interest remains for safe and low-demand predictive markers to identify patients at risk for adverse outcomes postaortic valve replacement.MethodsThis single-center retrospective study included patients receiving a standard planning CT scan prior to TAVR. Conventional CAD diagnostic tools, such as coronary artery calcium score and significant stenosis via invasive coronary angiography and coronary computed tomography angiography, were determined in addition to RCA PCAT attenuation using semiautomated software. These were assessed for their relationship with major adverse cardiovascular events (MACE) during a 24-month follow-up period.ResultsFrom a total of 62 patients (mean age: 82 ± 6.7 years), 15 (24.2%) patients experienced an event within the observation period, 10 of which were attributed to cardiovascular death. The mean RCA PCAT attenuation was higher in patients enduring MACE than that in those without an endpoint (−69.8 ± 7.5 vs. −74.6 ± 6.2, P = 0.02). Using a predefined cutoff of >−70.5 HU, 20 patients (32.3%) with high RCA PCAT attenuation were identified, nine (45%) of which met the endpoint within 2 years after TAVR. In a multivariate Cox regression model including conventional CAD diagnostic tools, RCA PCAT attenuation prevailed as the only marker with significant association with MACE (P = 0.02). After dichotomization of patients into high- and low-RCA PCAT attenuation groups, high attenuation was related to greater risk of MACE (hazard ration: 3.82, P = 0.011).ConclusionRCA PCAT attenuation appears to have predictive value also in a setting of concomitant AS in patients receiving TAVR. RCA PCAT attenuation was more reliable than conventional CAD diagnostic tools in identifying patients at risk for MACE . |
| first_indexed | 2024-03-13T10:02:07Z |
| format | Article |
| id | doaj.art-54d89c8757784d09a2e9db255ce24464 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-03-13T10:02:07Z |
| publishDate | 2023-05-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-54d89c8757784d09a2e9db255ce244642023-05-23T04:50:34ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2023-05-011010.3389/fcvm.2023.11920931192093Computed tomography–based pericoronary adipose tissue attenuation in patients undergoing TAVR: a novel method for risk assessmentAlexandra Steyer0Alexandra Steyer1Silvia Mas-Peiro2Silvia Mas-Peiro3Silvia Mas-Peiro4David M. Leistner5Valentina O. Puntmann6Eike Nagel7Eike Nagel8Damini Dey9Markus Goeller10Vitali Koch11Vitali Koch12Christian Booz13Thomas J. Vogl14Simon S. Martin15Simon S. Martin16Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, GermanyInstitute for Experimental and Translational Cardiovascular Imaging, Goethe University, University Hospital Frankfurt, Frankfurt, GermanyDepartment of Cardiology, University Hospital Frankfurt, Frankfurt, GermanyGerman Centre for Cardiovascular Research (DZHK), Berlin, GermanyCardiopulmonary Institute (CPI), Frankfurt am Main, GermanyDepartment of Cardiology, University Hospital Frankfurt, Frankfurt, GermanyInstitute for Experimental and Translational Cardiovascular Imaging, Goethe University, University Hospital Frankfurt, Frankfurt, GermanyInstitute for Experimental and Translational Cardiovascular Imaging, Goethe University, University Hospital Frankfurt, Frankfurt, GermanyGerman Centre for Cardiovascular Research (DZHK), Berlin, GermanyBiomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United StatesDepartment of Cardiology, Friedrich-Alexander-University Hospital Erlangen, Erlangen, GermanyDepartment of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, GermanyInstitute for Experimental and Translational Cardiovascular Imaging, Goethe University, University Hospital Frankfurt, Frankfurt, GermanyDepartment of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, GermanyDepartment of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, GermanyDepartment of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, GermanyInstitute for Experimental and Translational Cardiovascular Imaging, Goethe University, University Hospital Frankfurt, Frankfurt, GermanyObjectivesThis study aims to assess the attenuation of pericoronary adipose tissue (PCAT) surrounding the proximal right coronary artery (RCA) in patients with aortic stenosis (AS) and undergoing transcatheter aortic valve replacement (TAVR). RCA PCAT attenuation is a novel computed tomography (CT)–based marker for evaluating coronary inflammation. Coronary artery disease (CAD) in TAVR patients is common and usually evaluated prior to intervention. The most sensible screening method and consequential treatment approach are unclear and remain a matter of ceaseless discussion. Thus, interest remains for safe and low-demand predictive markers to identify patients at risk for adverse outcomes postaortic valve replacement.MethodsThis single-center retrospective study included patients receiving a standard planning CT scan prior to TAVR. Conventional CAD diagnostic tools, such as coronary artery calcium score and significant stenosis via invasive coronary angiography and coronary computed tomography angiography, were determined in addition to RCA PCAT attenuation using semiautomated software. These were assessed for their relationship with major adverse cardiovascular events (MACE) during a 24-month follow-up period.ResultsFrom a total of 62 patients (mean age: 82 ± 6.7 years), 15 (24.2%) patients experienced an event within the observation period, 10 of which were attributed to cardiovascular death. The mean RCA PCAT attenuation was higher in patients enduring MACE than that in those without an endpoint (−69.8 ± 7.5 vs. −74.6 ± 6.2, P = 0.02). Using a predefined cutoff of >−70.5 HU, 20 patients (32.3%) with high RCA PCAT attenuation were identified, nine (45%) of which met the endpoint within 2 years after TAVR. In a multivariate Cox regression model including conventional CAD diagnostic tools, RCA PCAT attenuation prevailed as the only marker with significant association with MACE (P = 0.02). After dichotomization of patients into high- and low-RCA PCAT attenuation groups, high attenuation was related to greater risk of MACE (hazard ration: 3.82, P = 0.011).ConclusionRCA PCAT attenuation appears to have predictive value also in a setting of concomitant AS in patients receiving TAVR. RCA PCAT attenuation was more reliable than conventional CAD diagnostic tools in identifying patients at risk for MACE .https://www.frontiersin.org/articles/10.3389/fcvm.2023.1192093/fullpericoronary adipose tissuecoronary artery diseasetranscatheter aortic valve replacementscomputed tomography angiographyrisk stratificationmajor adverse cardiovascular events |
| spellingShingle | Alexandra Steyer Alexandra Steyer Silvia Mas-Peiro Silvia Mas-Peiro Silvia Mas-Peiro David M. Leistner Valentina O. Puntmann Eike Nagel Eike Nagel Damini Dey Markus Goeller Vitali Koch Vitali Koch Christian Booz Thomas J. Vogl Simon S. Martin Simon S. Martin Computed tomography–based pericoronary adipose tissue attenuation in patients undergoing TAVR: a novel method for risk assessment Frontiers in Cardiovascular Medicine pericoronary adipose tissue coronary artery disease transcatheter aortic valve replacements computed tomography angiography risk stratification major adverse cardiovascular events |
| title | Computed tomography–based pericoronary adipose tissue attenuation in patients undergoing TAVR: a novel method for risk assessment |
| title_full | Computed tomography–based pericoronary adipose tissue attenuation in patients undergoing TAVR: a novel method for risk assessment |
| title_fullStr | Computed tomography–based pericoronary adipose tissue attenuation in patients undergoing TAVR: a novel method for risk assessment |
| title_full_unstemmed | Computed tomography–based pericoronary adipose tissue attenuation in patients undergoing TAVR: a novel method for risk assessment |
| title_short | Computed tomography–based pericoronary adipose tissue attenuation in patients undergoing TAVR: a novel method for risk assessment |
| title_sort | computed tomography based pericoronary adipose tissue attenuation in patients undergoing tavr a novel method for risk assessment |
| topic | pericoronary adipose tissue coronary artery disease transcatheter aortic valve replacements computed tomography angiography risk stratification major adverse cardiovascular events |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1192093/full |
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