title: Prognostic value of T1-mapping in TAVR patients: extra-cellular volume as a possible predictor for peri- and post-TAVR adverse events.
abstract: The benefit of a transcatheter aortic valve replacement (TAVR) can differ in patients, and therapy bears severe risks. High-degree aortic stenosis can lead to cardiac damage such as diffuse myocardial fibrosis, evaluable by extra-cellular volume (ECV) in CMR. Therefore, fibrosis might be a possible risk factor for unfavorable outcome after TAVR. We sought to assess the prognostic value of T1-mapping and ECV to predict adverse events during and after TAVR. The study population consisted of patients undergoing clinically indicated TAVR by performing additional CMR with native and contrast-enhanced T1-mapping sequences for additional evaluation of ECV. Study endpoints were congestive heart failure (CHF) and TAVR-associated conduction abnormalities defined as new onset of left bundle branch block (LBBB), AV-Block or implantation of a pacemaker. 94 patients were examined and followed. Median follow up time was 187 days (IQR 79-357 days). ECV was increased (>30 %) in 38 patients (40 %). There was no significant correlation between ECV and death, Hazard ratio (HR) 0.847 (95 % CI 0.335; 2.14), p = 0.72. ECV in patients with subsequent CHF was higher than in those without an event (33.5 ± 4.6 and 29.1 ± 4.1 %, respectively), but the difference just did not reach the level of significance HR 2.16 (95 % CI 0.969; 4.84), p = 0.06. Patients with post-TAVR conduction abnormality (LBBB, AV-block or pacemaker implantation) had statistically relevant lower ECV values compared to those without an event. Patients with an event had a mean ECV of 28.1 ± 3.16 %; patients without an event had a mean ECV of 29.8 ± 4.53, HR 0.56 (95 % CI 0.32; 0.96), p = 0.036. In this study, elevated myocardial ECV is a predictor of CHF by trend; CMR may be helpful in identifying patients with a high risk for post-TAVR cardiac decompensation benefitting from an intensified post-interventional surveillance. Patients with post-TAVR conductions abnormalities have a significantly decreased ECV. Nevertheless, it remains unclear which precise molecular tissue alteration is the protective factor or risk factor in this case.
authors.affiliation: Department of Radiology and Nuclear Medicine, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany.
authors.forename: Jonathan
authors.identifier: http://orcid.org/0000-0003-0698-965X
authors.initials: J
authors.lastname: Nadjiri
authors.affiliation: Department of Radiology and Nuclear Medicine, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany.
authors.forename: Hanna
authors.initials: H
authors.lastname: Nieberler
authors.affiliation: Department of Radiology and Nuclear Medicine, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Hendrich
authors.affiliation: Department of Radiology and Nuclear Medicine, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany.
authors.forename: Albrecht
authors.initials: A
authors.lastname: Will
authors.affiliation: Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany.
authors.forename: Costanza
authors.initials: C
authors.lastname: Pellegrini
authors.affiliation: Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Husser
authors.affiliation: Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Hengstenberg
authors.affiliation: Siemens Healthcare GmbH, Erlangen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Greiser
authors.affiliation: Department of Radiology and Nuclear Medicine, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Martinoff
authors.affiliation: Department of Radiology and Nuclear Medicine, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany. mhy@dhm.mhn.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Hadamitzky
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D054537:Atrioventricular Block / Q000209:etiology / Q000628:therapy; D002037:Bundle-Branch Block / Q000209:etiology / Q000628:therapy; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000379:methods; D002304:Cardiac Pacing, Artificial; D003287:Contrast Media / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D005682:Gadolinium / Q000008:administration & dosage; D005858:Germany; D006333:Heart Failure / Q000209:etiology; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006571:Heterocyclic Compounds / Q000008:administration & dosage; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D009942:Organometallic Compounds / Q000008:administration & dosage; D010138:Pacemaker, Artificial; D011237:Predictive Value of Tests; D065840:Protective Factors; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D006571:Heterocyclic Compounds; D009942:Organometallic Compounds; C062402:gadoteridol; D005682:Gadolinium
keywords: Conduction abnormalities; Extra cellular volume; Outcome after TAVR; Predictive value; T1-mapping