Key result
Higher post-TAVR pericoronary adipose tissue attenuation linked to ~83% greater MACE risk in obstructive CAD.
Why the study?
The study aimed to evaluate the prognostic value of pericoronary adipose tissue attenuation measured three months after TAVR in patients with aortic stenosis and obstructive CAD.
Does high pericoronary adipose tissue (PCAT) attenuation predict major adverse cardiac events in patients with severe aortic stenosis and obstructive coronary artery disease after transcatheter aortic valve replacement?
Cohort (n=226)
No
Does high pericoronary adipose tissue (PCAT) attenuation predict major adverse cardiac events in patients with severe aortic stenosis and obstructive coronary artery disease after transcatheter aortic valve replacement?
Effect estimate: HR 1.83 (95% CI 1.44-2.32)
p-value: p=<0.01
High pericoronary adipose tissue attenuation measured by CCTA 3 months post-TAVR is an independent predictor of MACE in patients with severe aortic stenosis and obstructive coronary artery disease, significantly improving risk stratification.
May enhance post-TAVR risk stratification in severe AS with CAD; hypothesis-generating and requires prospective validation.
Background: This study aimed to examine the prognostic value of pericoronary adipose tissue (PCAT) attenuation at three months after transcatheter aortic valve replacement (TAVR) in patients with aortic stenosis (AS) and obstructive coronary artery disease (CAD). Methods: This retrospective study included 226 patients with both obstructive CAD and AS who underwent TAVR. PCAT attenuation was measured three months post-TAVR using coronary computed tomography angiogram (CCTA) images. Univariable and multivariable Cox regression analyses were conducted to evaluate the association between PCAT attenuation and major adverse cardiac events (MACEs). Results: Of the 226 patients, 37 experienced MACEs during a median follow-up period of 1.5 years. High PCAT attenuation was significantly associated with MACEs (–65.3 Hounsfield units (HU) vs. –71.6 HU; p < 0.01). The optimal PCAT attenuation threshold of –67.5 HU, determined by receiver operating characteristic (ROC) curve analysis, showed 84% sensitivity and 75% specificity (area under the curve (AUC) = 0.88) for predicting MACEs. Multivariable Cox regression confirmed that higher PCAT attenuation was independently associated with an increased risk of MACEs (hazard ratio (HR) = 1.83, 95% confidence interval (CI): 1.44–2.32; p < 0.01). Inclusion of PCAT attenuation increased the C-index from 0.41 to 0.82 (p = 0.01) and the net reclassification improvement (NRI) by 0.55 (95% CI: 0.34–0.78; p = 0.01). Conclusions: PCAT attenuation was independently associated with the risk of MACEs in post-TAVR patients with obstructive CAD and AS, suggesting the potential utility of PCAT attenuation for risk stratification.
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Hu et al. (2025) conducted a cohort in Aortic stenosis and obstructive coronary artery disease (n=226). Higher pericoronary adipose tissue (PCAT) attenuation vs. Lower PCAT attenuation was evaluated on Major adverse cardiac events (MACE) (HR 1.83, 95% CI 1.44-2.32, p=<0.01). Higher pericoronary adipose tissue attenuation measured three months post-TAVR was independently associated with an increased risk of major adverse cardiac events (HR 1.83) in patients with aortic stenosis and obstructive coronary artery disease.
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