Prognostic role of extracardiac incidentalomas detected with computed tomography in patients with severe aortic stenosis candidates for transcatheter aortic valve replacement
Authors: Bianchi N , Pavasini R , Campo G C 
Published: November 2023

Abstract

Background
Aortic stenosis is one of the most common valvular heart diseases worldwide, especially among older individuals. According to the latest guidelines for the management of valvular heart disease, in patient with high surgical risk and aged 75 years and older, transcatheter aortic valve replacement (TAVR) is the first therapeutic option to be considered (1). Every patient undergoing TAVR should perform a computed tomography (CT) scan before percutaneous procedure. An incidentaloma is defined as an unexpected finding on a CT scan performed for another clinical reason.

Purpose
The purpose of this study is to determine the prognostic role of incidentalomas found on CT scan performed pre-TAVR procedure in elderly patients with severe aortic stenosis.

Methods
We performed a monocentric retrospective observational study of 284 patients with severe aortic stenosis evaluated for TAVR from January 2016 to December 2022. All data were collected retrospectively and processed anonymously. Patients' clinical data (past medical history, cardiovascular risk factors, comorbidities, echocardiogram and coronary artery angiography findings) were collected, and all CT scans were reviewed for the presence of incidentalomas. An incidentaloma was considered clinically relevant only if further investigations were required following its diagnosis. Statistical analyses were performed using Mann-Whitney test, uni- and multivariate Cox regression models. Only variables with p&lt;0,05 on univariate analysis were included in multivariate models. The primary endpoint of the study was delay in TAVR implantation. The secondary endpoint was death.

Results
We analyzed 284 patients’ data with a median age of 87 (83-90) years. The median follow-up was 713 (464-1130) days in which 165 (58%) patients underwent TAVR and 83 (29%) deceased. Among the patients, 43 incidentalomas were diagnosed (Table 1). About primary endpoint, within patients who underwent TAVR, median delay to the procedure was 217 (160-284) days and there was not statically difference in delay between patients with or without incidentalomas (Mann-Whitney test p=0,08) (Figure 1). Furthermore, about the secondary endpoint, incidentalomas were not associated with death on univariate analysis (p=0,38) (Figure 2). Atrial fibrillation, chronic kidney disease (CKD), dilatation of left ventricle, left ventricular ejection fraction (LVEF) and TAVR were statistically significant among patients survived or not. LVEF was not associated with outcome (p=0,06) on univariate Cox regression analysis. In multivariate model (Table 2) TAVR reduced risk of death, instead CKD and dilated left ventricle increased risk.

Conclusion
Between patients with severe aortic stenosis candidates for TAVR presence of clinically relevant incidentalomas on CT scan was not associated with significant delay in procedure or death. Further studies are needed to prospectively confirm these results on a larger cohort of patients.Table 1 and Table 2Figure 1 and Figure 2