PVAT Signaling as a Prognostic Marker in TAVR Context
- This study retrospectively examined consecutive patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR) to explore whether pre-procedural perivascular adipose tissue (PVAT) attenuation around the aortic valve relates to future cardiovascular events.
Study Design and Population
- Design: Retrospective analysis.
- Population: 233 patients with severe aortic stenosis treated with TAVR.
- Exposure: PVAT attenuation quantified on computed tomography angiography around the aortic valve prior to TAVR.
- Follow-up: Median duration 2.2 years.
Primary Outcome and Events
- Outcome of interest: Major adverse cardiovascular events (MACE), defined as a composite of all-cause death, stroke, and heart failure rehospitalization.
- Event rate: 23.6% experienced MACE during follow-up.
Key Quantitative Observations
- PVAT attenuation differed between outcome groups, with higher attenuation observed in the MACE group (mean −74.0 ± 9.8 HU) compared with the non-MACE group (mean −78.9 ± 9.2 HU); P value = 0.001.
- Multivariable analysis showed that higher PVAT attenuation was independently associated with MACE, yielding a hazard ratio of 1.52 (95% CI: 1.13–2.04; P = 0.006).
Contextual Interpretation and Incremental Value
- Adding PVAT attenuation to established prognostic factors after TAVR improved predictive performance and risk reclassification for MACE.
- The data suggest a relationship between elevated PVAT attenuation around the aortic valve and subsequent heart failure or cardiovascular death post-TAVR.
Limitations and Uncertainty
- The study is observational and retrospective, limiting causal inference.