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Objective <p>Pulmonary hypertension (PH) significantly affects outcomes after transcatheter aortic valve implantation (TAVI), with sex-specific differences indicating the need for tailored strategies. This study investigated the predictive value of CT-derived main pulmonary artery (MPA) dimensions and ratios, focusing on diagnostic accuracy and prognostic relevance in male and female TAVI patients.</p> Materials and methods <p>A retrospective analysis of 526 patients (263 male, 263 female) undergoing TAVI was performed. PH was defined echocardiographically according to European Society of Cardiology (ESC) guidelines. Pre-procedural CT measurements of MPA, ascending aorta (AA), and derived ratios (e.g., MPA/AA) were analyzed. Sex-specific cut-offs were determined using area under the receiver operating characteristic (AUROC) analyses and validated with survival curves and Cox regression.</p> Results <p>MPA and its ratios outperformed right and left pulmonary artery metrics in detecting PH. Overall cut-offs were MPA ≥ 29.5 mm and MPA/AA ≥ 0.76. In men, elevated MPA or MPA/AA showed strong associations with PH, whereas in women, higher cut-offs (MPA ≥ 30.0 mm; MPA/AA ≥ 0.86) were less diagnostically useful. Importantly, the MPA/AA ratio predicted long-term survival only in men (hazard ratio (HR) = 1.857, <i>p</i> = 0.006), underlining its limited prognostic role in females.</p> Conclusion <p>CT-derived pulmonary artery metrics are valuable for predicting PH and survival in male TAVI patients. Incorporating the MPA/AA ratio into clinical practice may improve risk stratification in men, while limited diagnostic utility in women highlights the need for alternative markers. Sex-specific approaches should be pursued to optimize outcomes across all PH etiologies.</p> Critical relevance statement <p>CT-derived pulmonary artery metrics reliably predict PH and long-term survival after TAVI, particularly in men, emphasizing their diagnostic and prognostic value while underscoring the need for sex-specific thresholds and alternative markers in women.</p> Key Points <p><UnorderedList Mark="Bullet"> <ItemContent> <p>PH impacts TAVI outcomes, yet sex-specific radiological predictors remain insufficiently investigated.</p> </ItemContent> <ItemContent> <p>The pulmonary artery to AA ratio predicted survival in men but showed no prognostic value for women.</p> </ItemContent> <ItemContent> <p>Implementing sex-specific imaging assessments improves risk stratification in men, highlighting the need for distinct diagnostic strategies for women.</p> </ItemContent> </UnorderedList></p> Graphical Abstract <p></p>

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Sex-specific utility of pulmonary artery metrics in predicting pulmonary hypertension and survival after TAVI: insights from advanced CT imaging

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月7日

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  • Elke Boxhammer,
  • Matthias Hammerer,
  • Nikolaos Schörghofer,
  • Nikolaus Clodi,
  • Erika Prinz,
  • Wilfried Wintersteller,
  • Uta C. Hoppe,
  • Klaus Hergan,
  • Christoph Knapitsch,
  • Bernhard Scharinger

摘要

Objective

Pulmonary hypertension (PH) significantly affects outcomes after transcatheter aortic valve implantation (TAVI), with sex-specific differences indicating the need for tailored strategies. This study investigated the predictive value of CT-derived main pulmonary artery (MPA) dimensions and ratios, focusing on diagnostic accuracy and prognostic relevance in male and female TAVI patients.

Materials and methods

A retrospective analysis of 526 patients (263 male, 263 female) undergoing TAVI was performed. PH was defined echocardiographically according to European Society of Cardiology (ESC) guidelines. Pre-procedural CT measurements of MPA, ascending aorta (AA), and derived ratios (e.g., MPA/AA) were analyzed. Sex-specific cut-offs were determined using area under the receiver operating characteristic (AUROC) analyses and validated with survival curves and Cox regression.

Results

MPA and its ratios outperformed right and left pulmonary artery metrics in detecting PH. Overall cut-offs were MPA ≥ 29.5 mm and MPA/AA ≥ 0.76. In men, elevated MPA or MPA/AA showed strong associations with PH, whereas in women, higher cut-offs (MPA ≥ 30.0 mm; MPA/AA ≥ 0.86) were less diagnostically useful. Importantly, the MPA/AA ratio predicted long-term survival only in men (hazard ratio (HR) = 1.857, p = 0.006), underlining its limited prognostic role in females.

Conclusion

CT-derived pulmonary artery metrics are valuable for predicting PH and survival in male TAVI patients. Incorporating the MPA/AA ratio into clinical practice may improve risk stratification in men, while limited diagnostic utility in women highlights the need for alternative markers. Sex-specific approaches should be pursued to optimize outcomes across all PH etiologies.

Critical relevance statement

CT-derived pulmonary artery metrics reliably predict PH and long-term survival after TAVI, particularly in men, emphasizing their diagnostic and prognostic value while underscoring the need for sex-specific thresholds and alternative markers in women.

Key Points

PH impacts TAVI outcomes, yet sex-specific radiological predictors remain insufficiently investigated.

The pulmonary artery to AA ratio predicted survival in men but showed no prognostic value for women.

Implementing sex-specific imaging assessments improves risk stratification in men, highlighting the need for distinct diagnostic strategies for women.

Graphical Abstract