What is the clinical evidence from this study?

Study design: Cohort. Population: Severe aortic stenosis (n=341). Intervention: High epicardial adipose tissue (EAT) volume (> 74 cm3) vs. Low EAT volume (≤ 74 cm3). Primary outcome: 5-year all-cause mortality (HR 1.59, 95% CI 1.04-2.41, p=0.031).

February 7, 2024Open Access

Epicardial adipose tissue as an independent predictor of long-term outcome in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement

Key Result

High epicardial adipose tissue volume (>74 cm3) independently predicted worse 5-year all-cause mortality (HR 1.59) in patients with severe aortic stenosis undergoing TAVR.

Study Design

Type

Cohort (n=341)

Multicenter

Structured PICO

Does high epicardial adipose tissue volume predict increased all-cause mortality in patients with severe aortic stenosis undergoing TAVR?

Population

341 patients with severe aortic stenosis (AS) diagnosed by transthoracic echocardiography assigned for transcatheter aortic valve replacement (TAVR), median age 80.9 years, 45% female.

Intervention

High epicardial adipose tissue (EAT) volume (≥74 cm³ measured on pre-TAVR planning CTs)

Comparator

Low epicardial adipose tissue (EAT) volume (<74 cm³)

Outcome

All-cause mortality at 5-year long-term follow-uphard clinical

Increased epicardial adipose tissue volume measured on pre-TAVR CT is an independent predictor of long-term all-cause mortality in patients with severe aortic stenosis.

Main Result

Effect estimate: HR 1.59 (95% CI 1.04-2.41)

Absolute Event Rate: 41% vs 30%

p-value: p=0.031

Limitations

Single-center cohort with a relatively small number of patients.
Calculation of EAT volumes using CT Hounsfield units is an estimation and might include other surrounding tissue.
The threshold of 74 cm3 of EAT volume might only apply to the investigated cohort.
Without a direct comparison with a matched control group, the impact of EAT might just be a surrogate for other comorbidities.

Abstract

Abstract Background Accurate risk stratification is important to improve patient selection and outcome of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). As epicardial adipose tissue (EAT) is discussed to be involved in cardiovascular disease, it could be useful as a marker of poor prognosis in patients with severe AS undergoing TAVR. Methods A total of 416 patients diagnosed with severe AS by transthoracic echocardiography were assigned for TAVR and enrolled for systematic assessment. Patients underwent clinical surveys and 5-year long-term follow-up, with all-cause mortality as the primary endpoint. EAT volume was quantified on pre-TAVR planning CTs. Patients were retrospectively dichotomized at the median of 74 cm 3 of EAT into groups with low EAT and high EAT volumes. Mortality rates were compared using Kaplan-Meyer plots and uni- and multivariable cox regression analyses. Results A total number of 341 of 416 patients (median age 80.9 years, 45% female) were included in the final analysis. Patients with high EAT volumes had similar short-term outcome ( p = 0.794) but significantly worse long-term prognosis ( p = 0.023) compared to patients with low EAT volumes. Increased EAT volumes were associated with worse long-term outcome (HR1.59; p = 0.031) independently from concomitant cardiovascular risk factors, general type of AS, and functional echocardiography parameters of AS severity (HR1.69; p = 0.013). Conclusion Increased EAT volume is an independent predictor of all-cause mortality in patients with severe AS undergoing TAVR. It can be easily obtained from pre-TAVR planning CTs and may thus qualify as a novel marker to improve prognostication and management of patient with severe AS. Trial registration DRKS, DRKS00024479. Graphical abstract AS, aortic stenosis; TAVR, transcatheter aortic valve replacement; EAT, epicardial adipose tissue

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