Impact of Potentially Malignant Incidental Findings by Computed Tomographic Angiography on Long-Term Survival After Transcatheter Aortic Valve Implantation

Abstract

Computed tomography angiography (CTA) in workup for transcatheter aortic valve implantation (TAVI) frequently reveals potentially malignant incidental findings. Most incidental findings provoke discussions on their influence. We aimed to analyze if these findings were a predictor of long-term survival after TAVI. In a single-center retrospective analysis, all consecutive patients with pre-TAVI CTA were included (years 2009 to 2014). Patients were divided by presence or absence of incidental findings. We analyzed up to 5 years of all-cause, non-cardiovascular and cardiovascular mortality for all 553 patients who underwent TAVI; 113 had a potentially malignant incidental finding (20.4%). At 5 years, all-cause mortality risk was 64.5% in patients with versus 49.1% in patients without a finding (hazard ratio [HR] 1.70, 95% confidence interval [CI] 1.25 to 2.31). After adjustment, the findings remained an independent predictor of all-cause (adjusted HR 1.46, 95% CI 1.07 to 1.99) and non-cardiovascular mortality (adjusted subdistribution HR 1.84, 95% CI 1.06 to 3.20), but not of cardiovascular mortality. In conclusion, the presence of potentially malignant incidental findings on CTA is an independent predictor of long-term all-cause and noncardiovascular mortality but not of cardiovascular mortality.

Outcomes of incidental findings on multi‐detector computed tomography for transcatheter aortic valve implantation assessment: A single‐centre study and review of the literature

“…The incidence of IF ranges from 20% to 100% due to different definitions of an IF and varying thresholds for reporting by individual radiologists . Renal and lung pathologies were the most commonly reported findings in our study and this is consistent with previous data . Of note, no dimensions or size was reported for most kidney nodules or cysts identified (69%) and similarly for 29% of lung lesions.…”

“…The impact that suspicious IF on MDCT have on overall survival remains unclear with several studies showing conflicting results (Table ). In a single‐centre retrospective analysis of 553 patients who underwent TAVI with a follow‐up of 5 years, a potentially malignant IF independently predicted all‐cause mortality (adjusted HR 1.46, 95% CI 1.07–1.99) . Conversely, a large single‐centre retrospective study of 1050 patients who underwent MDCT for TAVI workup described no difference in survival in TAVI patients with versus without clinically relevant IF at 30 days or 1 year .…”

“…Such findings may reduce the likelihood of receiving TAVI and delay time from MDCT to the TAVI procedure . Previous studies have focused on the impact of MDCT‐IF on survival, yielding conflicting results . Differences likely reflect variations in the definition of IF, the threshold of reporting findings, and malignant potential of individual findings.…”

Impact of cancer in patients with aortic stenosis undergoing transcatheter aortic valve replacement: A systematic review and meta-analysis

“…The remaining 33 studies underwent a full-text review, and 18 were excluded because they were irrelevant to the study question (n = 17) or because the full text was not retrieved (n = 1). Finally, 15 observational studies involving 195,658 patients were included, of which 38,695 (19.8%) included patients with cancer [3] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] . The baseline clinical characteristics of the patients are shown in Table 1 .…”

Diagnostic Work-Up of the Aortic Patient: An Integrated Approach toward the Best Therapeutic Option

“…Considering the wide range of MSCT acquisition and the elderly population, about 20% of preprocedural TAVI work-up MSCT has potentially malignant findings [66,67], which may alter the aortic valve treatment course. These incidental findings are associated with poorer survival in those without incidental findings; however, if these findings are addressed effectively in the best ongoing care, the differences in survival between those with and without incidental findings become negligible [67].…”