Aortic atheroma volume tied to post-TAVR mortality risk

Higher aortic atheroma volume (AAV) seems to aggravate the risk of mortality after transcatheter aortic valve replacement (TAVR), a recent study has found. Preoperative AAV measurement with computed tomography (CT) may be valuable in evaluating postprocedural prognosis.

The study included 143 patients (mean age 85.4±4.1 years, 73 percent women) with symptomatic severe aortic stenosis who underwent TAVR with preprocedural CT assessment. Over a median follow-up of 651 days, 24 all-cause deaths and 14 cardiac deaths occurred, yielding corresponding rates of 16.8 percent and 9.8 percent.

The median AAV was 63.6 mL, with values ranging from 28.5–174.7 mL. Patients with measurements above the median AAV were designated as the high-AAV group. Kaplan-Meier analysis showed that the high- vs low-AAV group had significantly elevated rates of all-cause (p=0.016) and cardiac (p=0.023) mortality.

Further stratifying AAV into the abdominal (Ab) and thoracic (T) segments showed that both all-cause and cardiac mortality rates were higher in patients with AbAAV values above the median (p=0.0043 and p=0.023, respectively), but no such effect was reported for TAAV.

Multivariable Cox regression analysis further confirmed that only high AbAAV was independently and significantly associated with excess all-cause mortality (hazard ratio, 1.06, 95 percent confidence interval, 1.001–1.11; p=0.046). Total AAV and TAAV showed no such interaction.

“The current study may suggest that the pre-procedural assessment of AAV is valuable for predicting prognosis after TAVR and is helpful for preventing futile interventions. However, further studies with a larger sample size are necessary to elaborate on this possible relationship,” the researchers said.