Impact of CT Incidental Lung Findings and Pulmonary Function on 3-Year Mortality after TAVR

M. Mousa Basha (Bonn)¹, J. Shamekhi (Bonn)¹, B. Al-Kassou (Bonn)¹, G. Nickenig (Bonn)¹, S. Zimmer (Bonn)¹, T. Beiert (Bonn)¹, M. Weber (Bonn)¹, D. Skowasch (Bonn)¹, C. Pizarro (Bonn)¹, F. Bakhtiary (Bonn)², D. Kütting (Bonn)³, J. Luetkens (Bonn)^3
1Universitätsklinikum Bonn Medizinische Klinik und Poliklinik II Bonn, Deutschland; ²Universitätsklinikum Bonn Klinik und Poliklinik für Herzchirurgie Bonn, Deutschland; ³Universitätsklinikum Bonn Radiologische Klinik Bonn, Deutschland

Background

Incidental pulmonary findings, particularly interstitial lung abnormalities (ILA) and emphysema are frequently observed in preprocedural computed tomography (CT) scans of patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). However, their prognostic significance remains unclear.

Objectives

To evaluate the impact of incidental ILA and emphysema on 3-year all-cause mortality and pulmonary function in TAVR patients.

Methods

We retrospectively analysed 572 patients who underwent transfemoral TAVR at the Heart Center Bonn between January 2018 and December 2021. All patients underwent preprocedural CT and comprehensive pulmonary function testing. Primary endpoint was 3-year all-cause mortality.

Results

Radiological evidence of emphysema was observed in 23.6% of patients, and ILA was present in 20.8%. While emphysema showed no association with 3-year mortality (log-rank p = 0.813), ILA was significantly associated with increased 3-year mortality (36.4% vs. 57.6%; p < 0.001). In multivariate analysis, ILA remained an independent predictor of mortality (HR 1.64, 95% CI 1.22–2.21, p = 0.001), alongside chronic kidney disease, NYHA class IV, and FEV₁ < 80% predicted. Stratified analysis revealed that the prognostic impact of reduced FEV1 was confined to patients with ILA (p = 0.008), whereas no significant association was observed in patients without ILA (p = 0.056). ILA patients demonstrated significantly impaired pulmonary function, with lower FVC (65.2 ± 16.6% vs. 72.0 ± 18.0%; p < 0.001), and decreased DLCO (47.4 ± 21.1% vs. 55.9 ± 21.1%; p = 0.019) compared to patients without ILA.

Conclusion

Incidental ILA detected on preprocedural CT is a strong and independent predictor of 3-year all-cause mortality in TAVR patients, whereas incidental emphysema did not impact mid-term outcomes. ILA was associated with a restrictive and diffusion-limited pulmonary function pattern, emphasizing the need for integrated preprocedural risk stratification that combines CT findings with pulmonary function tests to enable effective monitoring of interstitial lung disease progression.