What is the clinical evidence from this study?

Study design: Cohort. Population: Severe aortic stenosis (n=206). Intervention: Left atrial volume index (LAVI) ≥53.32 mL/m2 vs. LAVI <53.32 mL/m2. Primary outcome: Major adverse cardiovascular events (MACE) (HR 4.249, 95% CI 1.585-11.394, p=0.001).

What question did this study set out to answer?

To assess the relationship between preprocedural coronary computed tomography angiography-derived left atrial volume index and post-TAVR major adverse cardiovascular events in patients with severe aortic stenosis.

June 24, 2026Quantitative Imaging in Medicine and SurgeryOpen Access

Cardiac computed tomography-derived left atrial volume index as a predictor of major adverse cardiovascular events after transcatheter aortic valve replacement

Q: What are the key findings of this study?

Preprocedural CCTA-derived left atrial volume index ≥53.32 mL/m2 independently predicted an increased risk of major adverse cardiovascular events after transcatheter aortic valve replacement (HR 4.249).

Q: What does this research mean for the field?

Preprocedural coronary computed tomography angiography-derived left atrial volume index (LAVI) ≥53.32 mL/m2 independently predicts major adverse cardiovascular events after transcatheter aortic valve replacement in severe aortic stenosis. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To assess the relationship between preprocedural coronary computed tomography angiography-derived left atrial volume index and post-TAVR major adverse cardiovascular events in patients with severe aortic stenosis.

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Key result

Preprocedural high LAVI linked to ~4.2-fold higher post-TAVR MACE risk.

HR 4.249
95% CI 1.585-11.394
P=0.001
n=206

Why the study?

Does preprocedural CCTA-derived left atrial volume index independently predict major adverse cardiovascular events in patients with severe aortic stenosis undergoing TAVR?

Key Points

To assess the relationship between preprocedural coronary computed tomography angiography-derived left atrial volume index and post-TAVR major adverse cardiovascular events in patients with severe aortic stenosis.
Retrospective single-center study evaluating 206 patients with severe aortic stenosis (113 males, mean age 68.11±8.01 years) undergoing TAVR between February 2020 and June 2024.
Preprocedural coronary computed tomography angiography was used to automatically quantify left atrial volume indexed to body surface area.
Univariate, Firth-penalized Cox proportional hazards regression, and restricted cubic spline analyses evaluated predictors of major adverse cardiovascular events over a median follow-up of 581 days.
Major adverse cardiovascular events occurred in 13.1% (27/206) of patients, with median left atrial volume index significantly higher in affected individuals versus those without events (70.14 vs. 51.19 mL/m2, P<0.001).
Multivariable analysis adjusted for EuroSCORE II showed left atrial volume index ≥53.32 mL/m2 (HR =4.249, 95% CI: 1.585–11.394, P=0.001) and male sex (HR =2.864, 95% CI: 1.164–7.051, P=0.012) independently predicted post-TAVR events.
Restricted cubic spline analysis confirmed a significant nonlinear relationship between left atrial volume index and event risk (P for nonlinearity =0.032).

Study Design

Type

Cohort (n=206)

Multicenter

Structured PICO

Does preprocedural CCTA-derived left atrial volume index independently predict major adverse cardiovascular events in patients with severe aortic stenosis undergoing TAVR?

Population

206 adults with severe aortic stenosis undergoing transcatheter aortic valve replacement, followed for a median of 581 days.

Exposure

Preprocedural coronary computed tomography angiography (CCTA)-derived high left atrial volume index (LAVI ≥53.32 mL/m2)

Comparator

Preprocedural coronary computed tomography angiography (CCTA)-derived lower left atrial volume index (LAVI <53.32 mL/m2)

Outcome

Major adverse cardiovascular events (MACE), a composite of cardiac death, heart failure rehospitalization, stroke, nonfatal myocardial infarction, and unstable angina over a median follow-up of 581 dayscomposite

Main Result

Hazard Ratio: 4.249 (95% CI 1.585–11.394)

p-value: p=0.001

Preprocedural CCTA-derived left atrial volume index is a strong, independent predictor of major adverse cardiovascular events following TAVR, highlighting its potential utility as an opportunistic imaging biomarker for risk stratification.

Limitations

Retrospective single-center design inherently introduces potential biases.
Relatively small number of MACE events limited statistical power and precluded adjustment for multiple covariates.
ROC-derived cutoff was optimized for this dataset and may introduce optimistic bias, limiting generalizability.
Composite MACE endpoint included heterogeneous outcomes linked to LA remodeling through distinct mechanisms.
LAVI measurements were obtained only through automated CCTA analysis without comparison to echocardiographic measurements.
Exploratory interaction analysis between LAVI and sex was underpowered.
Retrospective single-center design inherently introduces potential biases
Relatively small number of MACE events limited statistical power and precluded adjustment for multiple covariates
ROC-derived cutoff was optimized for this dataset and may introduce optimistic bias, requiring external validation
Composite MACE endpoint included heterogeneous outcomes with too few heart-failure-related events for a well-powered subanalysis
Lack of comparison between CCTA-derived LAVI and echocardiographic LAVI
Exploratory interaction analysis between LAVI and sex was underpowered

Implication

LAVI ≥53.32 mL/m2 was associated with higher MACE risk post-TAVR; extends CCTA-LAVI utility for stratification but needs prospective validation.

Abstract

Background: Left atrial volume index (LAVI) has been recognized as a significant indicator of left heart remodeling and diastolic dysfunction. This study aimed to investigate the association between LAVI assessed by coronary computed tomography angiography (CCTA) and major adverse cardiovascular events (MACEs) in patients with severe aortic stenosis (AS) after transcatheter aortic valve replacement (TAVR). Methods: This retrospective single-center study enrolled patients with severe AS undergoing TAVR between February 2020 and June 2024. All patients underwent CCTA examination prior to TAVR. Left atrial (LA) volume was automatically quantified from CCTA images, and the LAVI was computed by indexing to body surface area (BSA). Univariate and Firth-penalized Cox proportional hazards regression analyses were used to determine the predictors of MACE. Additionally, restricted cubic spline analysis was performed to explore the relationship between LAVI and MACE. Results: A total of 206 patients (113 males, 93 females; mean age 68.11±8.01 years) were included in the final analysis. The incidence of MACE was 13.1% over a median follow-up time of 581 [interquartile range (IQR), 378–990] days. The LAVI was significantly higher in patients with MACE than in those without MACE [70.14 (54.81–84.12) vs. 51.19 (39.67–64.45) mL/m2, P<0.001]. After adjustment for clinical confounders and European System for Cardiac Operative Risk Evaluation (EuroSCORE II), LAVI ≥53.32 mL/m2 [hazard ratio (HR) =4.249, 95% confidence interval (CI): 1.585–11.394, P=0.001] and male sex (HR =2.864, 95% CI: 1.164–7.051, P=0.012) still independently predicted MACE. Restricted cubic spline results showed a nonlinear relationship between LAVI and MACE (P for nonlinearity =0.032). Conclusions: Preprocedural CCTA-derived LAVI may aid risk stratification for MACE after TAVR in severe AS. Male patients warrant closer postprocedural attention.

Discussion

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Published by Quantitative Imaging in Medicine and Surgery · CC BY-NC-ND

Cite This Study

Li et al. (2026) conducted a cohort in Severe aortic stenosis (n=206). Left atrial volume index (LAVI) ≥53.32 mL/m2 vs. LAVI <53.32 mL/m2 was evaluated on Major adverse cardiovascular events (MACE) (HR 4.249, 95% CI 1.585-11.394, p=0.001). Preprocedural CCTA-derived left atrial volume index ≥53.32 mL/m2 independently predicted an increased risk of major adverse cardiovascular events after transcatheter aortic valve replacement (HR 4.249).

synapsesocial.com/papers/6a3c239bd15afadd906fa504 https://doi.org/10.21037/qims-2026-1-0032

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Implication

LAVI ≥53.32 mL/m2 was associated with higher MACE risk post-TAVR; extends CCTA-LAVI utility for stratification but needs prospective validation.

Cardiac computed tomography-derived left atrial volume index as a predictor of major adverse cardiovascular events after transcatheter aortic valve replacement

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

Cardiac computed tomography-derived left atrial volume index as a predictor of major adverse cardiovascular events after transcatheter aortic valve replacement

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

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