Computed tomography-based pericoronary adipose tissue attenuation in patients undergoing TAVR: a novel method for risk assessment

Alexandra Steyer; Silvia Mas-Peiro; David M Leistner; Valentina O Puntmann; Eike Nagel; Damini Dey; Markus Goeller; Vitali Koch; Christian Booz; Thomas J Vogl; Simon S Martin

doi:10.3389/fcvm.2023.1192093

Computed tomography-based pericoronary adipose tissue attenuation in patients undergoing TAVR: a novel method for risk assessment

Front Cardiovasc Med. 2023 May 22:10:1192093. doi: 10.3389/fcvm.2023.1192093. eCollection 2023.

Authors

Alexandra Steyer^{1

2}, Silvia Mas-Peiro^{3

4

5}, David M Leistner³, Valentina O Puntmann², Eike Nagel^{2

4}, Damini Dey⁶, Markus Goeller⁷, Vitali Koch^{1

2}, Christian Booz¹, Thomas J Vogl¹, Simon S Martin^{1

2}

Affiliations

¹ Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany.
² Institute for Experimental and Translational Cardiovascular Imaging, Goethe University, University Hospital Frankfurt, Frankfurt, Germany.
³ Department of Cardiology, University Hospital Frankfurt, Frankfurt, Germany.
⁴ German Centre for Cardiovascular Research (DZHK), Berlin, Germany.
⁵ Cardiopulmonary Institute (CPI), Frankfurt am Main, Germany.
⁶ Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
⁷ Department of Cardiology, Friedrich-Alexander-University Hospital Erlangen, Erlangen, Germany.

Abstract

Objectives: This study aims to assess the attenuation of pericoronary adipose tissue (PCAT) surrounding the proximal right coronary artery (RCA) in patients with aortic stenosis (AS) and undergoing transcatheter aortic valve replacement (TAVR). RCA PCAT attenuation is a novel computed tomography (CT)-based marker for evaluating coronary inflammation. Coronary artery disease (CAD) in TAVR patients is common and usually evaluated prior to intervention. The most sensible screening method and consequential treatment approach are unclear and remain a matter of ceaseless discussion. Thus, interest remains for safe and low-demand predictive markers to identify patients at risk for adverse outcomes postaortic valve replacement.

Methods: This single-center retrospective study included patients receiving a standard planning CT scan prior to TAVR. Conventional CAD diagnostic tools, such as coronary artery calcium score and significant stenosis via invasive coronary angiography and coronary computed tomography angiography, were determined in addition to RCA PCAT attenuation using semiautomated software. These were assessed for their relationship with major adverse cardiovascular events (MACE) during a 24-month follow-up period.

Results: From a total of 62 patients (mean age: 82 ± 6.7 years), 15 (24.2%) patients experienced an event within the observation period, 10 of which were attributed to cardiovascular death. The mean RCA PCAT attenuation was higher in patients enduring MACE than that in those without an endpoint (-69.8 ± 7.5 vs. -74.6 ± 6.2, P = 0.02). Using a predefined cutoff of >-70.5 HU, 20 patients (32.3%) with high RCA PCAT attenuation were identified, nine (45%) of which met the endpoint within 2 years after TAVR. In a multivariate Cox regression model including conventional CAD diagnostic tools, RCA PCAT attenuation prevailed as the only marker with significant association with MACE (P = 0.02). After dichotomization of patients into high- and low-RCA PCAT attenuation groups, high attenuation was related to greater risk of MACE (hazard ration: 3.82, P = 0.011).

Conclusion: RCA PCAT attenuation appears to have predictive value also in a setting of concomitant AS in patients receiving TAVR. RCA PCAT attenuation was more reliable than conventional CAD diagnostic tools in identifying patients at risk for MACE .

Keywords: computed tomography angiography; coronary artery disease; major adverse cardiovascular events; pericoronary adipose tissue; risk stratification; transcatheter aortic valve replacements.

Grants and funding

SM-P was supported by a Cardio-Pulmonary Institute (CPI) grant and a German Center for Cardiovascular Research (DZHK) grant outside the submitted work. DML reports grants from DZHK (German Center for Cardiovascular Research) outside the submitted work. The other authors have no interfering relations to industry or other sources of funding.