Feasibility and Clinical Value of 3-Dimensional Myocardial Deformation Analysis by Computed Tomography in Transcatheter Aortic Valve Replacement Patients
Abstract
Purpose: Multi-phase computed tomography angiography (CTA) for the pre-procedural planning of TAVR presents a unique opportunity to assess 3D myocardial biomechanics. This study aimed to assess the feasibility and predictive utility of 3D myocardial deformation analysis (3D-MDA) based principal strain to predict heart failure or death following TAVR using pre-procedural, multi-phase computed tomography angiography (CTA) datasets.
Methods: Two hundred and five patients undergoing pre-TAVR multi-phase gated CTA followed by successful TAVR were retrospectively identified. Whole heart 3D mesh chamber models were generated followed by 3D-MDA of the left ventricle (LV) to determine global LV minimum principal strain (minPS) for endocardial, epicardial and transmural layers.
Results: Of the 205 patients, 196 (96%) had analyzable CTA data for 3D-MDA [median (IQR) age of 85 (79.588) years (55% male); STS-PROM score: 3.10 (2.104.55); and echocardiographic LVEF 60.0 (55.965.0)%]. At a median 25 (11–36) months following TAVR, 55 patients (28%) experienced a composite clinical outcome of heart failure hospitalization or death. Patients with a global minPS below a 23.7% experienced a 3-fold higher rate of the primary outcome (p
Conclusions: CT derived 3D-MDA is feasible and delivers novel deformation markers strongly and independently predictive of future cardiovascular outcomes in patients undergoing TAVR.