Key result
Pre-TAVR diastolic PA:AA ratio improves discrimination of persistent pulmonary hypertension over RVSP alone.
Why the study?
Does the pre-procedural CT-derived pulmonary artery to ascending aorta ratio (PA:AA) improve discrimination of post-TAVR pulmonary hypertension with elevated pulmonary vascular resistance compared to echocardiographic RVSP alone in patients undergoing TAVR?
Cohort (n=97)
No
Does the pre-procedural CT-derived pulmonary artery to ascending aorta ratio (PA:AA) improve discrimination of post-TAVR pulmonary hypertension with elevated pulmonary vascular resistance compared to echocardiographic RVSP alone in patients undergoing TAVR?
Answers are grounded in this paper and cite their sources.
Measuring the diastolic pulmonary artery-to-ascending aorta ratio on routine pre-TAVR CT provides incremental value over echocardiographic RVSP for identifying patients who will have persistent post-TAVR pulmonary hypertension with elevated pulmonary vascular resistance.
To investigate whether pre-transcatheter aortic valve replacement (TAVR) computed tomography (CT)-derived anatomical metrics are associated with post-TAVR pulmonary hypertension (PH) with elevated pulmonary vascular resistance (PVR). In this post-hoc analysis of a prospective single-center registry (Invasive PPM Registry; UMIN-CTR: 000054628), 97 patients undergoing TAVR with complete CT, echocardiography, and invasive hemodynamics were evaluated. Prespecified CT metrics included main, left and right pulmonary artery diameters, right ventricle/left ventricle ratio (RV/LV), right ventricular outflow tract wall thickness, septal deviation, and the pulmonary artery–to–ascending aorta ratio (PA:AA). The primary endpoint was post-TAVR PH with elevated PVR (mean pulmonary artery pressure > 20 mmHg and PVR > 2 Wood units). Incremental value beyond right ventricular systolic pressure (RVSP) was assessed. PH with elevated PVR occurred in 21 (21.6%) patients. Diastolic PA:AA showed the best discrimination, although this was modest (AUC 0.664, 95% CI 0.526–0.798), other metrics performed less well (AUCs 0.46–0.60). At the Youden-optimal threshold of ≥ 0.90, sensitivity was 61.9%, specificity 72.4%, positive predictive value 38.2% and negative predictive value 87.3%. RVSP discriminated poorly (AUC 0.558); adding PA:AA(d) improved discrimination (AUC 0.710; ΔAUC 0.152), model fit ( p = 0.015), risk separation (IDI 0.066; p = 0.020) and reclassification (category-free NRI 0.690; p = 0.024). PA:AA(d) correlated modestly with post-procedural mPAP (Spearman ρ = 0.247; p = 0.015). In this exploratory analysis, a larger pre-TAVR diastolic PA:AA ratio was associated with post-TAVR PH with elevated PVR and improved discrimination when combined with echocardiographic RVSP. Trial registration: This study was registered with the University Hospital Medical Information Network Clinical Trial Registry and accepted by the International Committee of Medical Journal Editors (UMIN ID: 000054628).
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Santillan et al. (2026) conducted a cohort in Aortic stenosis undergoing transcatheter aortic valve replacement (TAVR) (n=97). Pre-TAVR CT-derived diastolic pulmonary artery-to-ascending aorta ratio (PA:AA) vs. Other CT-derived anatomical metrics and echocardiographic right ventricular systolic pressure (RVSP) was evaluated on Post-TAVR pulmonary hypertension with elevated pulmonary vascular resistance (mean pulmonary artery pressure > 20 mmHg and PVR > 2 Wood units) (AUC 0.664, 95% CI 0.526-0.798). Pre-TAVR diastolic PA:AA ratio discriminated post-TAVR pulmonary hypertension with elevated PVR (AUC 0.664; 95% CI 0.526-0.798) and improved discrimination over RVSP alone (AUC 0.710; p=0.015).
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