End-diastolic aortic gap on initial cardiac ct and prognosis in lvad patients: comparison with echocardiographic aortic regurgitation
M Chao, C Teng, K E Ingram, N Ali, K Baser, A Dhore-Patil, V Modi, A Sinha, A Guha, S Chang, S H Little, K MahwashAbstract
Background
Aortic regurgitation (AR) is associated with adverse outcomes in patients supported with left ventricular assist devices (LVADs). Although echocardiography is the standard modality for AR assessment, image quality and grading reproducibility may be limited in selected clinical scenarios. Cardiac computed tomography (CT) offers high spatial resolution and may provide complementary structural markers.
Purpose
To evaluate whether an end-diastolic (ED) aortic gap identified on cardiac CT can serve as a surrogate marker of echocardiographic AR and to explore its association with long-term prognosis in LVAD patients.
Methods
In this retrospective single-centre study, LVAD patients who underwent both cardiac CT and transthoracic echocardiography within 180 days of implantation were analysed. On CT, the presence of an ED aortic gap was visually assessed on retrocardiac views during the ED phase and classified as absent (complete closure) or present (visible separation). Echocardiographic AR was assessed over multiple cardiac cycles and classified as present or absent. Patients were stratified according to CT and echocardiographic findings. Five-year all-cause mortality was evaluated using Kaplan–Meier analysis with log-rank testing.
Results
Patients without an ED aortic gap on CT demonstrated a low prevalence of AR on initial echocardiography (8.7%), whereas those with an ED gap showed a higher prevalence of AR (27.8%). CT-based stratification showed lower 5-year survival in patients without an ED gap compared with those with a gap (72% vs. 94%; log-rank p = 0.135). Similarly, echocardiographic stratification showed lower 5-year survival in patients without AR compared with those with AR (75% vs. 100%; log-rank p = 0.186). Survival trends were directionally consistent between CT- and echocardiography-based classifications.
Conclusion
The absence of an end-diastolic aortic gap on cardiac CT parallels echocardiographic findings and is associated with a trend toward poorer long-term prognosis in LVAD patients. ED aortic gap assessment on CT may provide complementary diagnostic and prognostic information, particularly when echocardiographic evaluation is limited.AR detect in Cardiac CT and EchoFor image description, please refer to the figure legend and surrounding text.Survival curve by Cardiac CT and ECHOFor image description, please refer to the figure legend and surrounding text.