Prognostic Value of CT-Derived Myocardial Biomarkers: Extracellular Volume Fraction and Strain in Patients with Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-analysis.

Xiangui He Yuxi Li Yong Wang Wei Tian Zhifan Li Long Ge Gang Wang Zixian Chen

Acad Radiol

Department of Radiology, The First Hospital of Lanzhou University, The First Clinical Medical College of Lanzhou University, Intelligent Imaging Medical Engineering Research Center of Gansu Province, Accurate Image Collaborative Innovation International Science and Technology Cooperation Base of Gansu Province, Gansu Province Clinical Research Center for Radiology Imaging, Lanzhou 73000, China (X.H., Y.L., Y.W., W.T., Z.L., G.W., Z.C.). Electronic address:

Published: November 2024

The study examined how preoperative CT scan-derived myocardial biomarkers can predict outcomes in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).* -
A total of 11 studies were analyzed, showing that both extracellular volume fraction (ECV) and left ventricular global longitudinal strain (LVGLS) significantly predict all-cause mortality and major cardiovascular events in these patients.* -
The research concluded that higher ECV and lower LVGLS values are associated with worse prognoses for patients with severe AS after TAVR, influenced by factors such as age and sex.*

Rationale And Objectives: This study aimed to investigate the prognostic value of preoperative CT scan-derived myocardial biomarkers in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).

Materials And Methods: In April 2024, three databases (PubMed, Web of Science and Embase) were searched to identify studies. A random-effects model for meta-analysis was conducted to calculate pooled hazard ratios (HR) and 95% confidence intervals (CI) to assess the prognostic value. The I statistic was used to assess heterogeneity. Meta-regression analysis was conducted to appraise which variables yielded a significant impact on the HR of included biomarkers.

Results: 11 studies were identified, of which six studies involved 678 patients reporting extracellular volume fraction (ECV), one study involved 300 patients reporting ECV and left ventricular global longitudinal strain (LVGLS), three studies involved 868 patients reporting LVGLS and one study involved 376 patients reporting LVGLS and peak left atrial longitudinal strain (PALS). The endpoints included all-cause mortality, major adverse cardiovascular events (MACE) and a composite outcome of the previous two. The meta-analysis revealed that ECV, whether considered as a dichotomous variable (pooled HR: 3.87, 95% CI: 2.63-5.70, I = 0%), or as a continuous variable (pooled HR: 1.12, 95% CI: 1.05-1.19, I = 66%), and LVGLS, whether considered as a dichotomous variable (pooled HR: 1.70, 95% CI: 1.30-2.22, I = 0%) or a continuous variable (pooled HR: 1.07, 95% CI: 1.04-1.10, I = 0%) were all significant predictors for outcomes in patients with severe AS after TAVR. Age, sex, follow-up time and mean pressure gradient had a significant impact on the model of ECV (continuous).

Conclusion: The higher CT-derived ECV and impaired LVGLS are able to predict worse outcomes in patients with severe AS who have undergone TAVR.

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http://dx.doi.org/10.1016/j.acra.2024.06.009	DOI Listing

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