New ways to predict TAVR outcomes for individual heart patients
Transcatheter aortic valve replacement (TAVR) is associated with consistently positive outcomes for patients with severe aortic stenosis. Complications still happen, though, and some patients may not be a good fit for the minimally invasive procedure.
Research teams all over the world remain focused on discovering new ways to predict short- and long-term TAVR outcomes. In fact, two separate studies were recently published online that explored different ways to anticipate the effectiveness of TAVR.
Using inflammation, immune system activity to anticipate TAVR survival
The first study, published in full in Medicina, explored the potential of using the C-reactive protein–albumin–lymphocyte (CALLY) index to predict all-cause mortality after TAVR.[1]
The CALLY index, researchers explained, is an “innovative biomarker” that examines systemic inflammation, immune system activity and nutrition all at once.
“Although increasing evidence indicates that inflammation and malnutrition are associated with adverse cardiovascular outcomes, their combined impact on patients with AS remains insufficiently defined,” wrote first author Zeynep Esra Güner, a researcher with Uzunköprü State Hospital in Turkey, and colleagues. “In particular, data on the nutritional status of older adults undergoing aortic valve replacement and its clinical relevance to postprocedural prognosis are limited. Considering the underlying inflammatory and nutrition-related mechanisms of the disease, the CALLY index, which provides a comprehensive reflection of the interaction between these two systems, is thought to offer additional prognostic value for risk assessment in patients undergoing TAVR.”
The group explored data from more than 300 patients who underwent TAVR at a single facility from 2018 to 2023. The mean follow-up period was 21 months.
Overall, 19.8% of patients died during the follow-up window. The CALLY index was associated to a high predictive performance for all-cause mortality with an area under the ROC curve of 0.698. In addition, a low CALLY index was an independent predictor of mortality in a multivariate Cox regression.
More research is still necessary, as this was a retrospective study, but these findings do suggest the CALLY index may offer more value to care teams than other immune-inflammatory biomarkers researchers have previously considered. The authors concluded by highlighting the “practical, low-cost” nature of this approach and describing the CALLY index as a “complementary tool for post-TAVR risk stratification.”
Click here for the full study.
AI-powered imaging assessments examine long-term mortality
For another new study, researchers with the Mayo Clinic in Rochester, Minnesota, considered the use of CT-derived body composition metrics to evaluate heart patients being considered for TAVR. The group published its findings in Mayo Clinic Proceedings: Digital Health.[2]
This study was larger, focusing on more than 2,500 TAVR patients treated at a high-volume facility from 2011 to 2023. The median age was 80 years old, and the mean follow-up time was 2.8 years. An advanced artificial intelligence model was used to evaluate CT angiography images and deliver insights into each patient’s skeletal muscle (SM), subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), intermuscular adipose tissue areas and skeletal muscle index (SMI).
“CT angiography, routinely performed as part of preprocedural TAVR planning, offers a unique opportunity for comprehensive assessment of body composition,” wrote first author Chia-Hao Liu, MD, a researcher with both Mayo Clinic and China Medical University Hospital, and colleagues. “To date, most studies have examined the impact of individual body composition parameters on short-term mortality and quality of life after TAVR, whereas their influence on longer-term outcomes remains less well characterized.”
Overall, these imaging evaluations confirmed that lower SM, SAT, VAT and SMI were all independently associated with a higher risk of all-cause mortality after three years. This suggests that performing such body composition assessments can teach care teams a great deal about a patient’s odds of survival before the procedure even takes place.
“External validation in larger, multicenter cohorts will be essential to confirm the generalizability of these findings,” the group wrote.
Click here to read the full analysis.
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.