Prognostic impact of identifying etiology of prosthetic valve dysfunction with CT

Gurmandeep S. Sandhu, Pratik S Velangi, Harmeet K Kharoud, Rebecca Freese, Jeremy S Markowitz, Felipe Kazmirczak, Prabhjot S. Nijjar

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: In patients with prosthetic heart valves (PHV), there are distinct treatment implications based on prosthetic valve dysfunction (PVD) etiology. We investigated whether evaluation for PVD etiology on computed tomography (CT) has prognostic value for adverse clinical outcomes.

METHODS: Consecutive patients with suspected PVD that had a clinically indicated contrast chest CT and echocardiogram done within 1 year of each other were identified retrospectively from the Prosthetic Heart Valve CT Registry at the University of Minnesota. CTs and echocardiograms were assessed for potential PVD etiologies of pannus, structural valve degeneration (SVD) and thrombus, as per standard guidelines. Kaplan-Meier and Cox regression analyses were performed to assess association with a composite outcome of reoperation and all-cause mortality.

RESULTS: 132 patients (51.5% male, mean age 62.1 ​± ​19.3 years) with suspected PVD were included. There were 97 tissue valves, 31 mechanical valves and 4 transcatheter valves. The location of the valve was as follows: 72 aortic, 45 mitral, 8 tricuspid, and 7 pulmonic. A PVD etiology was diagnosed on CT in 80 (60.6%) patients, and on echocardiography in 45 (34.1%) patients, largely driven by a diagnosis of SVD on both modalities. Significant univariate predictors of the composite outcome included CT diagnosis of SVD (P ​< ​0.001), echocardiography diagnosis of SVD (P ​< ​0.001), degree of prosthetic stenosis (P ​< ​0.001) and degree of prosthetic regurgitation (P ​< ​0.001). On multivariable analyses adjusted for age, sex, left ventricular function, degree of prosthetic stenosis and degree of prosthetic regurgitation, CT diagnosis of SVD was significantly associated with the composite outcome (HR: 1.79, 1.09-2.95) whereas echocardiography diagnosis of SVD was not (HR: 1.56, 0.98-2.46).

CONCLUSION: In patients with suspected PVD, CT assessment of SVD had prognostic significance for hard outcomes. CT should be considered in the diagnostic evaluation of patients with suspected PVD.

Original languageEnglish (US)
Pages (from-to)174-181
Number of pages8
JournalJournal of Cardiovascular Computed Tomography
Volume16
Issue number2
DOIs
StatePublished - Mar 1 2022

Bibliographical note

Funding Information:
Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1-TR002494 . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
© 2021 Society of Cardiovascular Computed Tomography

Keywords

  • Computed tomography
  • Echocardiography
  • Prosthetic heart valve
  • Structural valve degeneration
  • Predictive Value of Tests
  • Prognosis
  • Heart Valve Prosthesis
  • Humans
  • Middle Aged
  • Male
  • Tomography, X-Ray Computed
  • Prosthesis Failure
  • Heart Valve Prosthesis Implantation/adverse effects
  • Aged, 80 and over
  • Adult
  • Female
  • Aged
  • Retrospective Studies
  • Aortic Valve

PubMed: MeSH publication types

  • Journal Article

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