Incidental CT findings help predict TAVR mortality
Clinicians should pay close attention to any incidental lung findings identified when transcatheter aortic valve replacement (TAVR) patients undergo preprocedural CT scans. That is according to new findings published in Heart Lung, a journal from the American Association of Heart Failure Nurses.[1]
“Over the past decade, TAVR has transformed the therapeutic landscape of symptomatic severe aortic stenosis (AS),” wrote first author Mustafa Mousa Basha, MD, a researcher with University Hospital Bonn in Germany, and colleagues. “Pulmonary diseases are frequently co-existent in AS patients, often ranging from mild restriction to a mixed restrictive and obstructive pattern, and represent an important risk factor for postoperative complications following TAVR.”
Basha et al. explored data from nearly 600 patients who underwent TAVR at a single facility from January 2019 to December 2021. The mean patient age was 80.6 years old, and 41.4% were women. All patients underwent preprocedural CT and pulmonary functional testing as part of the planning process. The median follow-up period was three years.
Evidence of at least one incidental interstitial lung abnormality (ILA) was identified in 20.8% of TAVR patients. Incidental emphysema, meanwhile, was detected in 23.7% of patients. ILA was defined as “non-dependent ground-glass or reticular opacities, traction bronchiectasis, honeycombing or other fibrotic changes involving >5% of any lung zone.” Emphysema stood out as “areas of abnormally low attenuation involving >5% of any lung parenchyma.”
Overall, patients with an ILA faced a significantly higher risk of three-year mortality after TAVR than patients with no ILA (57.6% vs. 36.4%). From one prediction model to the next, these incidental lung findings were consistently found to be an independent predictor of three-year mortality.
Incidental emphysema, on the other hand, did not appear to increase a patient’s three-year mortality risk.
The authors also noted that ILA patients were linked to a “significantly impaired pulmonary function” in terms of forced vital capacity, forced expiratory volume at the first second and diffusing capacity of the lung for carbon monoxide.
“Our results highlight the need for a more integrated approach to TAVR evaluation, in which incidental findings on CT, particularly ILA, should be carefully interpreted in combination with pulmonary function tests to facilitate better follow-up and monitoring of interstitial lung disease progression,” the authors concluded.
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.