Epicardial Adipose Tissue, Cardiac Damage, and Mortality in Patients Undergoing TAVR for Aortic Stenosis

Overview

Journal Int J Cardiovasc Imaging

Publisher Springer

Date 2025 Jan 17

PMID 39825067

Authors

Pamela Pina

Daniel Lorenzatti

Annalisa Filtz

Andrea Scotti

Elena Virosta Gil

Juan Duarte Torres

Cristina Morante Perea

Leslee J Shaw

Carl J Lavie

Daniel S Berman

Gianluca Iacobellis

Piotr J Slomka

Philippe Pibarot

Marc R Dweck

Damini Dey

Mario J Garcia

Azeem Latib

Leandro Slipczuk

Affiliations

Soon will be listed here.

Abstract

Computed tomography (CT)-derived Epicardial Adipose Tissue (EAT) is linked to cardiovascular disease outcomes. However, its role in patients undergoing Transcatheter Aortic Valve Replacement (TAVR) and the interplay with aortic stenosis (AS) cardiac damage (CD) remains unexplored. We aim to investigate the relationship between EAT characteristics, AS CD, and all-cause mortality. We retrospectively included consecutive patients who underwent CT-TAVR followed by TAVR. EAT volume and density were estimated using a deep-learning platform and CD was assessed using echocardiography. Patients were classified according to low/high EAT volume and density. All-cause mortality at 4 years was compared using Kaplan-Meier and Cox regression analyses. A total of 666 patients (median age 81 [74-86] years; 54% female) were included. After a median follow-up of 1.28 (IQR 0.53-2.57) years, 11.7% (n = 77) of patients died. The EAT volume (p = 0.017) decreased, and density increased (p < 0.001) with worsening AS CD. Patients with low EAT volume (< 49cm) and high density (≥-86 HU) had higher all-cause mortality (log-rank p = 0.02 and p = 0.01, respectively), even when adjusted for age, sex, and clinical characteristics (HR 1.71, p = 0.02 and HR 1.73, p = 0.03, respectively). When CD was added to the model, low EAT volume (HR 1.67 p = 0.03) and CD stages 3 and 4 (HR 3.14, p = 0.03) remained associated with all-cause mortality. In patients with AS undergoing TAVR, CT-derived low EAT volume, and high density were independently associated with increased 4-year mortality and worse CD stage. Only EAT volume remained associated when adjusted for CD.

References

Tezuka T, Higuchi R, Hagiya K, Saji M, Takamisawa I, Nanasato M . Midterm Outcomes of Underweight Patients Undergoing Transcatheter Aortic Valve Implantation: Insight From the LAPLACE-TAVR Registry. JACC Asia. 2023; 3(1):78-89. PMC: 9982279. DOI: 10.1016/j.jacasi.2022.08.014. View

Salam B, Al-Kassou B, Weinhold L, Sprinkart A, Nowak S, Theis M . CT-derived Epicardial Adipose Tissue Inflammation Predicts Outcome in Patients Undergoing Transcatheter Aortic Valve Replacement. J Thorac Imaging. 2024; 39(4):224-231. DOI: 10.1097/RTI.0000000000000776. View

Raggi P, Gadiyaram V, Zhang C, Chen Z, Lopaschuk G, Stillman A . Statins Reduce Epicardial Adipose Tissue Attenuation Independent of Lipid Lowering: A Potential Pleiotropic Effect. J Am Heart Assoc. 2019; 8(12):e013104. PMC: 6645620. DOI: 10.1161/JAHA.119.013104. View

Nakazato R, Shmilovich H, Tamarappoo B, Cheng V, Slomka P, Berman D . Interscan reproducibility of computer-aided epicardial and thoracic fat measurement from noncontrast cardiac CT. J Cardiovasc Comput Tomogr. 2011; 5(3):172-9. PMC: 3114269. DOI: 10.1016/j.jcct.2011.03.009. View

Snir A, Ng M, Strange G, Playford D, Stewart S, Celermajer D . Prevalence and Outcomes of Low-Gradient Severe Aortic Stenosis-From the National Echo Database of Australia. J Am Heart Assoc. 2021; 10(22):e021126. PMC: 8751961. DOI: 10.1161/JAHA.121.021126. View

Iacobellis G . Epicardial adipose tissue in contemporary cardiology. Nat Rev Cardiol. 2022; 19(9):593-606. PMC: 8926097. DOI: 10.1038/s41569-022-00679-9. View

Davin L, Nchimi A, Ilardi F, Dulgheru R, Marchetta S, Gach O . Epicardial Adipose Tissue and Myocardial Fibrosis in Aortic Stenosis Relationship With Symptoms and Outcomes: A Study Using Cardiac Magnetic Resonance Imaging. JACC Cardiovasc Imaging. 2018; 12(1):213-214. DOI: 10.1016/j.jcmg.2018.06.025. View

Ludwig S, Gossling A, Waldschmidt L, Linder M, Bhadra O, Voigtlander L . TAVR for low-flow, low-gradient aortic stenosis: Prognostic impact of aortic valve calcification. Am Heart J. 2020; 225:138-148. DOI: 10.1016/j.ahj.2020.03.013. View

Koike H, Fukui M, Treibel T, Stanberry L, Cheng V, Enriquez-Sarano M . Comprehensive Myocardial Assessment by Computed Tomography: Impact on Short-Term Outcomes After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Imaging. 2023; 17(4):396-407. DOI: 10.1016/j.jcmg.2023.08.008. View

10.

Pugliese N, Paneni F, Mazzola M, De Biase N, Punta L, Gargani L . Impact of epicardial adipose tissue on cardiovascular haemodynamics, metabolic profile, and prognosis in heart failure. Eur J Heart Fail. 2021; 23(11):1858-1871. DOI: 10.1002/ejhf.2337. View

11.

Parisi V, Rengo G, Pagano G, DEsposito V, Passaretti F, Caruso A . Epicardial adipose tissue has an increased thickness and is a source of inflammatory mediators in patients with calcific aortic stenosis. Int J Cardiol. 2015; 186:167-9. DOI: 10.1016/j.ijcard.2015.03.201. View

12.

Adams D, Narayan O, Munnur R, Cameron J, Wong D, Talman A . Ethnic differences in coronary plaque and epicardial fat volume quantified using computed tomography. Int J Cardiovasc Imaging. 2016; 33(2):241-249. DOI: 10.1007/s10554-016-0982-1. View

13.

Sato T, Yufu K, Yamasaki H, Harada T, Yamauchi S, Ishii Y . Quality of epicardial adipose tissue predicts major adverse cerebral and cardiovascular events following transcatheter aortic valve implantation. Heart Vessels. 2024; 39(7):646-653. DOI: 10.1007/s00380-024-02374-w. View

14.

James Edelman J, Thourani V . Racial Disparity in the Treatment of Aortic Stenosis. J Am Heart Assoc. 2021; 10(14):e019875. PMC: 8483495. DOI: 10.1161/JAHA.120.019875. View

15.

Spaziano M, Chieffo A, Watanabe Y, Chandrasekhar J, Sartori S, Lefevre T . Computed tomography predictors of mortality, stroke and conduction disturbances in women undergoing TAVR: A sub-analysis of the WIN-TAVI registry. J Cardiovasc Comput Tomogr. 2018; 12(4):338-343. DOI: 10.1016/j.jcct.2018.04.007. View

16.

Blanke P, Weir-McCall J, Achenbach S, Delgado V, Hausleiter J, Jilaihawi H . Computed tomography imaging in the context of transcatheter aortic valve implantation (TAVI) / transcatheter aortic valve replacement (TAVR): An expert consensus document of the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr. 2019; 13(1):1-20. DOI: 10.1016/j.jcct.2018.11.008. View

17.

Nathan A, Yang L, Yang N, Eberly L, Khatana S, Dayoub E . Racial, Ethnic, and Socioeconomic Disparities in Access to Transcatheter Aortic Valve Replacement Within Major Metropolitan Areas. JAMA Cardiol. 2021; 7(2):150-157. PMC: 8600460. DOI: 10.1001/jamacardio.2021.4641. View

18.

Gallone G, Depaoli A, DAscenzo F, Tore D, Allois L, Bruno F . Impact of computed-tomography defined sarcopenia on outcomes of older adults undergoing transcatheter aortic valve implantation. J Cardiovasc Comput Tomogr. 2021; 16(3):207-214. DOI: 10.1016/j.jcct.2021.12.001. View

19.

Eberhard M, Stocker D, Meyer M, Kebernik J, Stahli B, Frauenfelder T . Epicardial adipose tissue volume is associated with adverse outcomes after transcatheter aortic valve replacement. Int J Cardiol. 2019; 286:29-35. DOI: 10.1016/j.ijcard.2019.01.068. View

20.

Quarta C, Solomon S, Uraizee I, Kruger J, Longhi S, Ferlito M . Left ventricular structure and function in transthyretin-related versus light-chain cardiac amyloidosis. Circulation. 2014; 129(18):1840-9. DOI: 10.1161/CIRCULATIONAHA.113.006242. View