Impact of Pulmonary Artery Dilatation on Clinical Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement

OBJECTIVES The aim of this study was to evaluate the clinical impact of computed tomography (CT)-derived pul-monary artery dilatation (PAD) in patients undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND Several studies have reported an association between pulmonary hypertension and cardiovascular events, but the prognostic value of PAD in patients undergoing TAVR remains unclear. METHODS The preprocedural computed tomographic studies of patients who underwent TAVR at Cedars-Sinai Medical Center between November 2013 and December 2017 were analyzed. Patients were divided into 2 groups according to the presence of PAD assessed on CT (pulmonary artery [PA] diameter $29 mm). The primary endpoint was all-cause mor-tality at 2 years. RESULTS A total of 895 patients were included (mean age 81.3 +/- 8.5 years), with a mean Society of Thoracic Surgeons score of 4.8%. The median PA diameter was 28.0 mm, and PAD was observed in 369 patients (41.2%). Compared with the no-PAD group, the PAD group had higher Society of Thoracic Surgeons scores and higher rates of atrial fibrillation, chronic kidney disease, and chronic obstructive pulmonary disease. The PAD group had higher 2-year all-cause mortality than the no-PAD group (28.9% vs 12.8%; P < 0.001), and PAD was independently associated with mortality (adjusted HR: 2.21; 95% CI: 1.44-3.39; P < 0.001). Furthermore, PAD had strong prognostic power in the subgroup analysis, stratified according to PA pressure (>36 mm Hg). CONCLUSIONS CT-derived PAD is a significant prognostic factor in patients undergoing TAVR. (J Am Coll Cardiol Intv 2021;14:2560-2569) Published by Elsevier on behalf of the American College of Cardiology Foundation.

Automated summary

The study found that CT-derived PAD is a significant prognostic factor in patients undergoing TAVR, and is independently associated with 2-year all-cause mortality.