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Article Abstract
Background: There is little data about the prognostic value of mitral annular dilatation (MAD) in patients with symptomatic severe aortic regurgitation (AR) undergoing transcatheter aortic valve replacement (TAVR). This study aimed to assess the prognosis value of computed tomography (CT)-determined MAD in such patients.
Methods: Consecutive patients with symptomatic severe AR who underwent pre-TAVR CT between May 2014 and May 2023 were included in this study. The clinical endpoint was the composite outcome of all-cause death and heart-failure hospitalization. Mitral annular dimensions were systematically measured by CT. A receiver operating characteristic (ROC) curve analysis was performed to obtain an ideal body surface area standardized cut-off value for MAD. A Cox regression analysis was performed to examine the association between MAD and composite outcomes. The incremental prognostic value of MAD was evaluated by calculating the net reclassification improvement and the integrated discrimination improvement.
Results: Among the 281 patients (72.6±7.5 years, 33.1% female), 41 (14.6%) reached the clinical endpoint during a median follow-up period of 2.0 years. MAD was identified in 132 (47.0%) patients based on a ROC cut-off value of 71.3 mm/m. The multivariable Cox analysis, which included clinical and echocardiographic parameters, confirmed that MAD [hazard ratio (HR): 4.07; 95% confidence interval (CI): 1.85-8.99; P=0.001) was associated with the composite outcome. Importantly, MAD provided incremental prognostic value over clinical and echocardiographic characteristics [net reclassification improvement: 0.40 (95% CI: 0.21-0.54), P=0.01; integrated discrimination improvement: 0.06 (95% CI: 0.01-0.14), P=0.02].
Conclusions: MAD was an independent predictor of adverse outcomes after TAVR in patients with severe AR, and added incremental prognostic value to a baseline model composed of clinical and echocardiographic characteristics.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11847191 | PMC |
| http://dx.doi.org/10.21037/qims-24-1608 | DOI Listing |
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