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<p>Computed tomography (CT)-derived Epicardial Adipose Tissue (EAT) is linked to cardiovascular disease outcomes. However, its role in patients undergoing Transcatheter Aortic Valve Replacement (TAVR) and the interplay with aortic stenosis (AS) cardiac damage (CD) remains unexplored. We aim to investigate the relationship between EAT characteristics, AS CD, and all-cause mortality. We retrospectively included consecutive patients who underwent CT-TAVR followed by TAVR. EAT volume and density were estimated using a deep-learning platform and CD was assessed using echocardiography. Patients were classified according to low/high EAT volume and density. All-cause mortality at 4 years was compared using Kaplan-Meier and Cox regression analyses. A total of 666 patients (median age 81 [74–86] years; 54% female) were included. After a median follow-up of 1.28 (IQR 0.53–2.57) years, 11.7% (<i>n</i> = 77) of patients died. The EAT volume (<i>p</i> = 0.017) decreased, and density increased (<i>p</i> &lt; 0.001) with worsening AS CD. Patients with low EAT volume (&lt; 49cm<sup>3</sup>) and high density (≥-86 HU) had higher all-cause mortality (log-rank <i>p</i> = 0.02 and <i>p</i> = 0.01, respectively), even when adjusted for age, sex, and clinical characteristics (HR 1.71, <i>p</i> = 0.02 and HR 1.73, <i>p</i> = 0.03, respectively). When CD was added to the model, low EAT volume (HR 1.67 <i>p</i> = 0.03) and CD stages 3 and 4 (HR 3.14, <i>p</i> = 0.03) remained associated with all-cause mortality. In patients with AS undergoing TAVR, CT-derived low EAT volume, and high density were independently associated with increased 4-year mortality and worse CD stage. Only EAT volume remained associated when adjusted for CD.</p> Graphical Abstract <p></p>

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Epicardial adipose tissue, cardiac damage, and mortality in patients undergoing TAVR for aortic stenosis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年1月18日

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  • Pamela Piña,
  • Daniel Lorenzatti,
  • Annalisa Filtz,
  • Andrea Scotti,
  • Elena Virosta Gil,
  • Juan Duarte Torres,
  • Cristina Morante Perea,
  • Leslee J. Shaw,
  • Carl J. Lavie,
  • Daniel S. Berman,
  • Gianluca Iacobellis,
  • Piotr J. Slomka,
  • Philippe Pibarot,
  • Marc R. Dweck,
  • Damini Dey,
  • Mario J. Garcia,
  • Azeem Latib,
  • Leandro Slipczuk

摘要

Computed tomography (CT)-derived Epicardial Adipose Tissue (EAT) is linked to cardiovascular disease outcomes. However, its role in patients undergoing Transcatheter Aortic Valve Replacement (TAVR) and the interplay with aortic stenosis (AS) cardiac damage (CD) remains unexplored. We aim to investigate the relationship between EAT characteristics, AS CD, and all-cause mortality. We retrospectively included consecutive patients who underwent CT-TAVR followed by TAVR. EAT volume and density were estimated using a deep-learning platform and CD was assessed using echocardiography. Patients were classified according to low/high EAT volume and density. All-cause mortality at 4 years was compared using Kaplan-Meier and Cox regression analyses. A total of 666 patients (median age 81 [74–86] years; 54% female) were included. After a median follow-up of 1.28 (IQR 0.53–2.57) years, 11.7% (n = 77) of patients died. The EAT volume (p = 0.017) decreased, and density increased (p < 0.001) with worsening AS CD. Patients with low EAT volume (< 49cm3) and high density (≥-86 HU) had higher all-cause mortality (log-rank p = 0.02 and p = 0.01, respectively), even when adjusted for age, sex, and clinical characteristics (HR 1.71, p = 0.02 and HR 1.73, p = 0.03, respectively). When CD was added to the model, low EAT volume (HR 1.67 p = 0.03) and CD stages 3 and 4 (HR 3.14, p = 0.03) remained associated with all-cause mortality. In patients with AS undergoing TAVR, CT-derived low EAT volume, and high density were independently associated with increased 4-year mortality and worse CD stage. Only EAT volume remained associated when adjusted for CD.

Graphical Abstract