Key result
High right coronary artery pericoronary adipose tissue attenuation (≥-70.5 HU) was associated with a significantly greater risk of major adverse cardiovascular events after TAVR (HR 3.82).
Why the study?
CAD screening and treatment approaches in TAVR patients remain unclear, highlighting the need for safe, low-demand predictive markers of adverse post-procedural outcomes.
Does CT-based right coronary artery pericoronary adipose tissue (RCA PCAT) attenuation predict major adverse cardiovascular events in patients with aortic stenosis undergoing TAVR?
Cohort (n=62)
Blinded outcome assessment
No
Does CT-based right coronary artery pericoronary adipose tissue (RCA PCAT) attenuation predict major adverse cardiovascular events in patients with aortic stenosis undergoing TAVR?
Hazard Ratio: 3.82 (95% CI 1.35–10.78)
Absolute Event Rate: 45% vs 14.3%
p-value: p=0.011
RCA PCAT attenuation derived from routine pre-TAVR CT scans is a significant predictor of MACE and outperforms conventional CAD diagnostic tools in this population.
RCA PCAT attenuation may enhance MACE risk stratification; hypothesis-generating in this small retrospective cohort and should not yet change practice.
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 .
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Steyer et al. (2023) conducted a cohort in Aortic stenosis undergoing TAVR (n=62). High RCA PCAT attenuation (≥-70.5 HU) vs. Low RCA PCAT attenuation (<-70.5 HU) was evaluated on Major adverse cardiovascular events (MACE: composite of cardiovascular death, stroke, and myocardial infarction) (HR 3.82, 95% CI 1.35-10.78, p=0.011). High right coronary artery pericoronary adipose tissue attenuation (≥-70.5 HU) was associated with a significantly greater risk of major adverse cardiovascular events after TAVR (HR 3.82).
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