Caglayan Demirel MD , Kevin Hamzaraj MD , Anna Seeber , Rayyan Hemetsberger MD , Sophia Koschatko MD , Charlotte Jantsch MD , Kseniya Halavina MD , Carolina Dona MD , Matthias Koschutnik MD , Katharina Mascherbauer MD , Gregor Heitzinger MD , Varius Dannenberg MD , Christian Nitsche MD , Martin Andreas MD, PhD , Christian Hengstenberg MD , Philipp E Bartko MD, PhD , Andreas Kammerlander MD, PhD
{"title":"骨矿密度与 TAVR 结果：增强型和非增强型 TAVR CT 扫描患者的对比分析。","authors":"Caglayan Demirel MD , Kevin Hamzaraj MD , Anna Seeber , Rayyan Hemetsberger MD , Sophia Koschatko MD , Charlotte Jantsch MD , Kseniya Halavina MD , Carolina Dona MD , Matthias Koschutnik MD , Katharina Mascherbauer MD , Gregor Heitzinger MD , Varius Dannenberg MD , Christian Nitsche MD , Martin Andreas MD, PhD , Christian Hengstenberg MD , Philipp E Bartko MD, PhD , Andreas Kammerlander MD, PhD","doi":"10.1016/j.hrtlng.2024.10.014","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Preprocedural evaluation, including frailty estimation, is crucial in managing patients undergoing Transcatheter Aortic Valve Replacement (TAVR). This involves mandatory computed tomography (CT) scans for assessing body composition parameters. The impact of low bone mineral density (BMD) on TAVR outcomes remains unclear, especially when measured using both non-enhanced and contrast-enhanced CT scans.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to evaluate the influence of low bone mineral density (BMD) on survival following TAVR and to assess the feasibility of BMD measurement conducted with non-enhanced and enhanced TAVR CT scans.</div></div><div><h3>Methods</h3><div>A cohort of consecutive TAVR-scheduled patients (<em>n</em> = 725, November 2015 to March 2022) with available enhanced and non-enhanced CT scans were included. BMD was quantified on a single axial image at the thoracic vertebrae level in both unenhanced and enhanced CT scans, and low BMD was defined as <200 HU. Cox regression was performed for cofounders, which are mainly associated with osteoporosis.</div></div><div><h3>Results</h3><div>A total of 725 patients were included in the study, with 54.1 % being male and a mean age of 80.7 ± 7.3 years. Out of these, 175 patients died during a median follow-up period of 837 days. Lower BMD in patients assessed using non-enhanced CT scans was significantly associated with reduced survival, even after adjusting for predictors of osteoporosis (<em>p</em> = 0.046). However, this association was not observed in patients who underwent contrast-enhanced CT scans (<em>p</em> = 0.830).</div></div><div><h3>Conclusion</h3><div>Opportunistic BMD measurements on non-enhanced TAVR-CT scans are feasible and a predictor for poor adverse after TAVR, providing valuable insights for comprehensive frailty assessments. This underscores the significance of incorporating non-enhanced BMD assessments into the preprocedural evaluations of TAVR patients. However, this association was not observed in contrast-enhanced CT scans.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"70 ","pages":"Pages 8-13"},"PeriodicalIF":2.4000,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Bone mineral density and TAVR outcome: A comparative analysis between patients with enhanced and non-enhanced TAVR CT scans\",\"authors\":\"Caglayan Demirel MD , Kevin Hamzaraj MD , Anna Seeber , Rayyan Hemetsberger MD , Sophia Koschatko MD , Charlotte Jantsch MD , Kseniya Halavina MD , Carolina Dona MD , Matthias Koschutnik MD , Katharina Mascherbauer MD , Gregor Heitzinger MD , Varius Dannenberg MD , Christian Nitsche MD , Martin Andreas MD, PhD , Christian Hengstenberg MD , Philipp E Bartko MD, PhD , Andreas Kammerlander MD, PhD\",\"doi\":\"10.1016/j.hrtlng.2024.10.014\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Preprocedural evaluation, including frailty estimation, is crucial in managing patients undergoing Transcatheter Aortic Valve Replacement (TAVR). This involves mandatory computed tomography (CT) scans for assessing body composition parameters. The impact of low bone mineral density (BMD) on TAVR outcomes remains unclear, especially when measured using both non-enhanced and contrast-enhanced CT scans.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to evaluate the influence of low bone mineral density (BMD) on survival following TAVR and to assess the feasibility of BMD measurement conducted with non-enhanced and enhanced TAVR CT scans.</div></div><div><h3>Methods</h3><div>A cohort of consecutive TAVR-scheduled patients (<em>n</em> = 725, November 2015 to March 2022) with available enhanced and non-enhanced CT scans were included. BMD was quantified on a single axial image at the thoracic vertebrae level in both unenhanced and enhanced CT scans, and low BMD was defined as <200 HU. Cox regression was performed for cofounders, which are mainly associated with osteoporosis.</div></div><div><h3>Results</h3><div>A total of 725 patients were included in the study, with 54.1 % being male and a mean age of 80.7 ± 7.3 years. Out of these, 175 patients died during a median follow-up period of 837 days. Lower BMD in patients assessed using non-enhanced CT scans was significantly associated with reduced survival, even after adjusting for predictors of osteoporosis (<em>p</em> = 0.046). However, this association was not observed in patients who underwent contrast-enhanced CT scans (<em>p</em> = 0.830).</div></div><div><h3>Conclusion</h3><div>Opportunistic BMD measurements on non-enhanced TAVR-CT scans are feasible and a predictor for poor adverse after TAVR, providing valuable insights for comprehensive frailty assessments. This underscores the significance of incorporating non-enhanced BMD assessments into the preprocedural evaluations of TAVR patients. However, this association was not observed in contrast-enhanced CT scans.</div></div>\",\"PeriodicalId\":55064,\"journal\":{\"name\":\"Heart & Lung\",\"volume\":\"70 \",\"pages\":\"Pages 8-13\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2024-11-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Heart & Lung\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0147956324002048\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Heart & Lung","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0147956324002048","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Bone mineral density and TAVR outcome: A comparative analysis between patients with enhanced and non-enhanced TAVR CT scans
Background
Preprocedural evaluation, including frailty estimation, is crucial in managing patients undergoing Transcatheter Aortic Valve Replacement (TAVR). This involves mandatory computed tomography (CT) scans for assessing body composition parameters. The impact of low bone mineral density (BMD) on TAVR outcomes remains unclear, especially when measured using both non-enhanced and contrast-enhanced CT scans.
Objectives
The purpose of this study was to evaluate the influence of low bone mineral density (BMD) on survival following TAVR and to assess the feasibility of BMD measurement conducted with non-enhanced and enhanced TAVR CT scans.
Methods
A cohort of consecutive TAVR-scheduled patients (n = 725, November 2015 to March 2022) with available enhanced and non-enhanced CT scans were included. BMD was quantified on a single axial image at the thoracic vertebrae level in both unenhanced and enhanced CT scans, and low BMD was defined as <200 HU. Cox regression was performed for cofounders, which are mainly associated with osteoporosis.
Results
A total of 725 patients were included in the study, with 54.1 % being male and a mean age of 80.7 ± 7.3 years. Out of these, 175 patients died during a median follow-up period of 837 days. Lower BMD in patients assessed using non-enhanced CT scans was significantly associated with reduced survival, even after adjusting for predictors of osteoporosis (p = 0.046). However, this association was not observed in patients who underwent contrast-enhanced CT scans (p = 0.830).
Conclusion
Opportunistic BMD measurements on non-enhanced TAVR-CT scans are feasible and a predictor for poor adverse after TAVR, providing valuable insights for comprehensive frailty assessments. This underscores the significance of incorporating non-enhanced BMD assessments into the preprocedural evaluations of TAVR patients. However, this association was not observed in contrast-enhanced CT scans.
期刊介绍：
Heart & Lung: The Journal of Cardiopulmonary and Acute Care, the official publication of The American Association of Heart Failure Nurses, presents original, peer-reviewed articles on techniques, advances, investigations, and observations related to the care of patients with acute and critical illness and patients with chronic cardiac or pulmonary disorders.
The Journal''s acute care articles focus on the care of hospitalized patients, including those in the critical and acute care settings. Because most patients who are hospitalized in acute and critical care settings have chronic conditions, we are also interested in the chronically critically ill, the care of patients with chronic cardiopulmonary disorders, their rehabilitation, and disease prevention. The Journal''s heart failure articles focus on all aspects of the care of patients with this condition. Manuscripts that are relevant to populations across the human lifespan are welcome.
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