Prognostic impact of identifying etiology of prosthetic valve dysfunction with CT

Gurmandeep S Sandhu; Pratik S Velangi; Harmeet Kharoud; Rebecca Freese; Jeremy Markowitz; Felipe Kazmirczak; Prabhjot S Nijjar

doi:10.1016/j.jcct.2021.10.008

Prognostic impact of identifying etiology of prosthetic valve dysfunction with CT

J Cardiovasc Comput Tomogr. 2022 Mar-Apr;16(2):174-181. doi: 10.1016/j.jcct.2021.10.008. Epub 2021 Oct 30.

Authors

Gurmandeep S Sandhu¹, Pratik S Velangi², Harmeet Kharoud³, Rebecca Freese⁴, Jeremy Markowitz¹, Felipe Kazmirczak¹, Prabhjot S Nijjar⁵

Affiliations

¹ Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
² Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
³ School of Public Health, University of Minnesota, Minneapolis, MN, USA.
⁴ Clinical and Translational Science Institute, Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis, MN, USA.
⁵ Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA. Electronic address: nijja003@umn.edu.

PMID: 34740558
DOI: 10.1016/j.jcct.2021.10.008

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.

Keywords: Computed tomography; Echocardiography; Prosthetic heart valve; Structural valve degeneration.

MeSH terms

Adult
Aged
Aged, 80 and over
Aortic Valve
Female
Heart Valve Prosthesis Implantation* / adverse effects
Heart Valve Prosthesis*
Humans
Male
Middle Aged
Predictive Value of Tests
Prognosis
Prosthesis Failure
Retrospective Studies
Tomography, X-Ray Computed