LAUSR

BACKGROUND Increase in pulmonary artery diameter (PAD) in multi-detector computed tomography (MDCT) may indicate pulmonary hypertension. We assessed the prognostic value of MDCT-derived measurements of pulmonary artery diameter (PAD) on outcomes after successful transcatheter aortic valve replacement (TAVR). METHODS Consecutive patients treated with TAVR from 02/2013 to 10/2017 with a 68.8% rate of new generation valves, underwent pre-interventional MDCT with measurements of PAD (in the widest short-axis within 3 cm of the bifurcation) and ascending aortic diameter (AoD; at the level of the PAD). PAD/AoD ratio was calculated. Patients with high-density lipoprotein cholesterol level ≤46 mg/dl and C-reactive protein level ≥0.20 mg/dl at baseline were identified as the frail group. The 1-year mortality was established for all subjects. RESULTS Among studied 266 patients (median age, 82.0 years; 63.5% women) those who died at 1-year (n = 34; 12.8%) had larger PAD and PAD/AoD (28.9 [5.0] vs. 26.5 [4.6] mm and 0.81 [0.13] vs. 0.76 [0.13] vs. the rest of the studied subjects; P = 0.005 and P = 0.02, respectively), but similar AoD. Cutoff value for the PAD to predict 1-year mortality was 29.3 mm (sensitivity, 50%; specificity, 77%; area under the curve, 0.65). Patients with PAD >29.3 mm (n = 72; 27%) had higher 1-year mortality (23.6% vs. 8.8%, log-rank P = 0.001). Baseline characteristics associated with PAD >29.3 mm were bigger body mass index, more frequent diabetes mellitus, more prior stroke/transient ischemic attack and atrial fibrillation, and lower baseline maximal aortic valve gradient with higher pulmonary artery systolic pressure (PASP). PAD >29.3 mm and frailty, but not baseline PASP, remained predictive of 1-year mortality in the multivariable model (hazard ratio [HR], 2.221; 95% CI, 1.038-4.753; P = 0.04 and HR, 2.801; 95% CI, 1.328-5.910; P = 0.007, respectively). CONCLUSION PAD >29.3 mm in baseline MDCT is associated with higher 1-year mortality after TAVR, independently of echocardiographic measure of PH and frailty.