Impact of CT incidental lung findings and pulmonary function on 3-year mortality after transcatheter aortic valve replacement (TAVR)

Background: Incidental pulmonary findings, particularly interstitial lung abnormalities (ILA) and emphysema are frequently observed in preprocedural computed tomography (CT) scans of patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). However, their prognostic significance remains unclear. Objectives: To evaluate the impact of incidental lung findings on 3-year all-cause mortality and pulmonary function in TAVR patients. Methods: In this retrospective study, we analysed 572 patients who underwent transfemoral TAVR at the Heart Center Bonn between January 2018 and December 2021. All patients underwent preprocedural CT and comprehensive pulmonary function testing. Primary endpoint was 3-year all-cause mortality. Results: Radiological evidence of ILA was present in 20.8%. ILA was significantly associated with increased 3-year mortality (57.6% vs. 36.4%; p < 0.001). In multivariable analysis, ILA remained an independent predictor of mortality (HR 1.59, 95% CI 1.17–2.19, p=0.004), alongside FVC < 80% predicted. Stratified analysis revealed that the prognostic impact of reduced FVC was confined to patients with ILA (p = 0.015), whereas no significant association was observed in patients without ILA (p = 0.058). ILA patients demonstrated significantly impaired pulmonary function, with lower FVC (65.2 ± 16.6% vs. 72.0 ± 18.0%; p < 0.001), and decreased DLCO (47.4 ± 21.1% vs. 55.9 ± 21.1%; p=0.019) compared to patients without ILA. Conclusion: Incidental ILA detected on preprocedural CT is a strong and independent predictor of 3-year mortality in TAVR patients. ILA was associated with a restrictive and diffusion-limited pulmonary function pattern, emphasizing the need of integration of pulmonary function tests to facilitate better follow-up and monitoring of interstitial lung disease progression.