School of Medicine and Health Sciences Poster Presentations

Title

What are the Implications of Non-Cardiac Findings in Patients Undergoing Evaluation for TAVR?

Document Type

Poster

Abstract Category

Cardiology/Cardiovascular Research

Keywords

Interventional Cardiology, Aortic Valve Disease

Publication Date

Spring 5-1-2019

Abstract

Cardiac CT with body and vascular imaging (CCT) is essential in transcatheter aortic valve replacement (TAVR) planning for patients with severe aortic stenosis (AS). Clinical and prognostic implications of significant non-cardiac findings (NCF) are not well defined. This study is aimed to evaluate the impact of NCF on downstream testing and outcomes. Patients undergoing TAVR work-up with CCT had NCF grouped by body system. Clinically significant (CS) findings were defined as need for a procedure or clinical referral. Outcomes included valve-related and non valve-related hospitalizations, major bleeding, cardiac events, as well as 1 month and 1 year mortality. Survival was assessed by Kaplan-Meier and by a cox proportional hazards regression model. N=152 had CCT for TAVR work-up. Patients who received TAVR (n=120) were 79 ± 9 years, 33% female, 66% high risk, and 16% inoperable. For TAVR patients, all (100%) had NCF, but n=33 (27%) were clinically significant. The most common CS NCF were a lung nodule (8, 6%) or abdominal cyst (10, 8%). CS NCF prompted 45 referrals or procedures. 2/152 (1%) patients were deferred for malignancy. Mortality and outcomes were similar between TAVR patients with and without CS NCF at 1 month and 1 year (p=NS). 27% of TAVR patients had CS NCF, but this did not impact 1 year mortality and outcomes. 1% of referred patients were deferred due to malignancy. These findings may guide the Heart Team in proceeding with TAVR without undue delay for most severe AS patients.

Open Access

1

Comments

Presented at Research Days 2019.

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What are the Implications of Non-Cardiac Findings in Patients Undergoing Evaluation for TAVR?

Cardiac CT with body and vascular imaging (CCT) is essential in transcatheter aortic valve replacement (TAVR) planning for patients with severe aortic stenosis (AS). Clinical and prognostic implications of significant non-cardiac findings (NCF) are not well defined. This study is aimed to evaluate the impact of NCF on downstream testing and outcomes. Patients undergoing TAVR work-up with CCT had NCF grouped by body system. Clinically significant (CS) findings were defined as need for a procedure or clinical referral. Outcomes included valve-related and non valve-related hospitalizations, major bleeding, cardiac events, as well as 1 month and 1 year mortality. Survival was assessed by Kaplan-Meier and by a cox proportional hazards regression model. N=152 had CCT for TAVR work-up. Patients who received TAVR (n=120) were 79 ± 9 years, 33% female, 66% high risk, and 16% inoperable. For TAVR patients, all (100%) had NCF, but n=33 (27%) were clinically significant. The most common CS NCF were a lung nodule (8, 6%) or abdominal cyst (10, 8%). CS NCF prompted 45 referrals or procedures. 2/152 (1%) patients were deferred for malignancy. Mortality and outcomes were similar between TAVR patients with and without CS NCF at 1 month and 1 year (p=NS). 27% of TAVR patients had CS NCF, but this did not impact 1 year mortality and outcomes. 1% of referred patients were deferred due to malignancy. These findings may guide the Heart Team in proceeding with TAVR without undue delay for most severe AS patients.