Two-year survival of patients screened for transcatheter aortic valve replacement with potentially malignant incidental findings in initial body computed tomography
Recently, transcatheter aortic valve replacement (TAVR) has evolved as the standard treatment in patients with inoperable aortic valve stenosis. According to TAVR guidelines, body computed tomography (CT) is recommended for pre-procedural planning. Due to the advanced age of these patients, multiple...
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| Veröffentlicht in: | European heart journal cardiovascular imaging 2015-07, Vol.16 (7), p.731-737 |
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| creator | Stachon, Peter Kaier, Klaus Milde, Simone Pache, Gregor Sorg, Stefan Siepe, Matthias von zur Mühlen, Constantin Zirlik, Andreas Beyersdorf, Friedhelm Langer, Mathias Zehender, Manfred Bode, Christoph Reinöhl, Jochen |
| description | Recently, transcatheter aortic valve replacement (TAVR) has evolved as the standard treatment in patients with inoperable aortic valve stenosis. According to TAVR guidelines, body computed tomography (CT) is recommended for pre-procedural planning. Due to the advanced age of these patients, multiple radiological potentially malignant incidental findings (pmIFs) appear in this cohort. It is unknown how pmIFs influence the decision by the heart team to intervene and the mortality.
We evaluated in a retrospective single-centre observational study 414 participants screened for TAVR with dual-source CT between October 2010 and December 2012. pmIFs are common and appeared in 18.7% of all patients screened for TAVR. The decision to intervene by TAVR or surgical aortic valve replacement (SAVR) was made by an interdisciplinary heart team and the role of pmIF in decision-making and time to treatment with TAVR or SAVR was analysed, retrospectively. The appearance of a pmIF vs. no pmIF did not significantly influence therapeutic decisions [odds ratio (OR) 1.14; P = 0.835] or time to treatment (91 ± 152 vs. 61 ± 109 days, respectively). Several findings, which are highly suspicious for malignancy, were less likely associated with invasive treatment (OR 0.207; P = 0.046). Patient survival was evaluated for at least 2 years until January 2014. Two-year survival of patients after TAVR or SAVR, treated according to the heart team decision, was ∼75% and independent from the presence of a non-severe (P = 0.923) or severe (P = 0.823) pmIF.
The study indicates that frequently occurring radiologic pmIF did not influence 2-year survival after a decision to intervene was made by an interdisciplinary heart team. |
| doi_str_mv | 10.1093/ehjci/jev055 |
| format | Article |
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We evaluated in a retrospective single-centre observational study 414 participants screened for TAVR with dual-source CT between October 2010 and December 2012. pmIFs are common and appeared in 18.7% of all patients screened for TAVR. The decision to intervene by TAVR or surgical aortic valve replacement (SAVR) was made by an interdisciplinary heart team and the role of pmIF in decision-making and time to treatment with TAVR or SAVR was analysed, retrospectively. The appearance of a pmIF vs. no pmIF did not significantly influence therapeutic decisions [odds ratio (OR) 1.14; P = 0.835] or time to treatment (91 ± 152 vs. 61 ± 109 days, respectively). Several findings, which are highly suspicious for malignancy, were less likely associated with invasive treatment (OR 0.207; P = 0.046). Patient survival was evaluated for at least 2 years until January 2014. Two-year survival of patients after TAVR or SAVR, treated according to the heart team decision, was ∼75% and independent from the presence of a non-severe (P = 0.923) or severe (P = 0.823) pmIF.
The study indicates that frequently occurring radiologic pmIF did not influence 2-year survival after a decision to intervene was made by an interdisciplinary heart team.</description><identifier>ISSN: 2047-2404</identifier><identifier>EISSN: 2047-2412</identifier><identifier>DOI: 10.1093/ehjci/jev055</identifier><identifier>PMID: 25759083</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Aged ; Aged, 80 and over ; Aortic Valve Stenosis - diagnostic imaging ; Aortic Valve Stenosis - epidemiology ; Aortic Valve Stenosis - surgery ; Cohort Studies ; Female ; Humans ; Incidental Findings ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoplasms - diagnostic imaging ; Neoplasms - mortality ; Original ; Preoperative Care - methods ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Risk Assessment ; Statistics, Nonparametric ; Survival Analysis ; Time Factors ; Tomography, X-Ray Computed - methods ; Transcatheter Aortic Valve Replacement - methods ; Transcatheter Aortic Valve Replacement - mortality ; Treatment Outcome ; Ultrasonography</subject><ispartof>European heart journal cardiovascular imaging, 2015-07, Vol.16 (7), p.731-737</ispartof><rights>The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology.</rights><rights>The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology. 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c384t-51eee7dfdea1be56325fc56dafb944a3d3a47c199c6dd6509054b4aff0d0aad3</citedby><cites>FETCH-LOGICAL-c384t-51eee7dfdea1be56325fc56dafb944a3d3a47c199c6dd6509054b4aff0d0aad3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25759083$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Stachon, Peter</creatorcontrib><creatorcontrib>Kaier, Klaus</creatorcontrib><creatorcontrib>Milde, Simone</creatorcontrib><creatorcontrib>Pache, Gregor</creatorcontrib><creatorcontrib>Sorg, Stefan</creatorcontrib><creatorcontrib>Siepe, Matthias</creatorcontrib><creatorcontrib>von zur Mühlen, Constantin</creatorcontrib><creatorcontrib>Zirlik, Andreas</creatorcontrib><creatorcontrib>Beyersdorf, Friedhelm</creatorcontrib><creatorcontrib>Langer, Mathias</creatorcontrib><creatorcontrib>Zehender, Manfred</creatorcontrib><creatorcontrib>Bode, Christoph</creatorcontrib><creatorcontrib>Reinöhl, Jochen</creatorcontrib><title>Two-year survival of patients screened for transcatheter aortic valve replacement with potentially malignant incidental findings in initial body computed tomography</title><title>European heart journal cardiovascular imaging</title><addtitle>Eur Heart J Cardiovasc Imaging</addtitle><description>Recently, transcatheter aortic valve replacement (TAVR) has evolved as the standard treatment in patients with inoperable aortic valve stenosis. According to TAVR guidelines, body computed tomography (CT) is recommended for pre-procedural planning. Due to the advanced age of these patients, multiple radiological potentially malignant incidental findings (pmIFs) appear in this cohort. It is unknown how pmIFs influence the decision by the heart team to intervene and the mortality.
We evaluated in a retrospective single-centre observational study 414 participants screened for TAVR with dual-source CT between October 2010 and December 2012. pmIFs are common and appeared in 18.7% of all patients screened for TAVR. The decision to intervene by TAVR or surgical aortic valve replacement (SAVR) was made by an interdisciplinary heart team and the role of pmIF in decision-making and time to treatment with TAVR or SAVR was analysed, retrospectively. The appearance of a pmIF vs. no pmIF did not significantly influence therapeutic decisions [odds ratio (OR) 1.14; P = 0.835] or time to treatment (91 ± 152 vs. 61 ± 109 days, respectively). Several findings, which are highly suspicious for malignancy, were less likely associated with invasive treatment (OR 0.207; P = 0.046). Patient survival was evaluated for at least 2 years until January 2014. Two-year survival of patients after TAVR or SAVR, treated according to the heart team decision, was ∼75% and independent from the presence of a non-severe (P = 0.923) or severe (P = 0.823) pmIF.
The study indicates that frequently occurring radiologic pmIF did not influence 2-year survival after a decision to intervene was made by an interdisciplinary heart team.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aortic Valve Stenosis - diagnostic imaging</subject><subject>Aortic Valve Stenosis - epidemiology</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Humans</subject><subject>Incidental Findings</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoplasms - diagnostic imaging</subject><subject>Neoplasms - mortality</subject><subject>Original</subject><subject>Preoperative Care - methods</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Statistics, Nonparametric</subject><subject>Survival Analysis</subject><subject>Time Factors</subject><subject>Tomography, X-Ray Computed - methods</subject><subject>Transcatheter Aortic Valve Replacement - methods</subject><subject>Transcatheter Aortic Valve Replacement - mortality</subject><subject>Treatment Outcome</subject><subject>Ultrasonography</subject><issn>2047-2404</issn><issn>2047-2412</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVUcFq3DAQNaElCUluPRcde6gb2ZK860uhhLYpBHrZuxhLo7UW2XIl2cH_kw-tkk2WdhDMMPPmvUGvKD5U9EtFW3aL_UHZ2wMuVIiz4rKmfFPWvKrfnWrKL4qbGA80h-ANr6vz4qIWG9HSLbssnnaPvlwRAolzWOwCjnhDJkgWxxRJVAFxRE2MDyQFGKOC1GPCQMCHZBXJGwuSgJMDhUNeIo829WTyKdcWnFvJAM7uR8gjOyqrcz-rGDtqO-5j7uVnn6Gk83olyg_TnLJk8oPfB5j69bp4b8BFvHnNV8Xux_fd3X358Pvnr7tvD6ViW55KUSHiRhuNUHUoGlYLo0SjwXQt58A0A75RVduqRutG0DZ_SMfBGKopgGZXxdcj7TR3A2qVDw3g5BTsAGGVHqz8fzLaXu79IjlvGKU8E3x6JQj-z4wxycFGhc7BiH6Osmq22-xCy2mGfj5CVfAxBjQnmYrKZ2vli7XyaG2Gf_z3tBP4zUj2F50CqR8</recordid><startdate>20150701</startdate><enddate>20150701</enddate><creator>Stachon, Peter</creator><creator>Kaier, Klaus</creator><creator>Milde, Simone</creator><creator>Pache, Gregor</creator><creator>Sorg, Stefan</creator><creator>Siepe, Matthias</creator><creator>von zur Mühlen, Constantin</creator><creator>Zirlik, Andreas</creator><creator>Beyersdorf, Friedhelm</creator><creator>Langer, Mathias</creator><creator>Zehender, Manfred</creator><creator>Bode, Christoph</creator><creator>Reinöhl, Jochen</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20150701</creationdate><title>Two-year survival of patients screened for transcatheter aortic valve replacement with potentially malignant incidental findings in initial body computed tomography</title><author>Stachon, Peter ; Kaier, Klaus ; Milde, Simone ; Pache, Gregor ; Sorg, Stefan ; Siepe, Matthias ; von zur Mühlen, Constantin ; Zirlik, Andreas ; Beyersdorf, Friedhelm ; Langer, Mathias ; Zehender, Manfred ; Bode, Christoph ; Reinöhl, Jochen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c384t-51eee7dfdea1be56325fc56dafb944a3d3a47c199c6dd6509054b4aff0d0aad3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aortic Valve Stenosis - diagnostic imaging</topic><topic>Aortic Valve Stenosis - epidemiology</topic><topic>Aortic Valve Stenosis - surgery</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Humans</topic><topic>Incidental Findings</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoplasms - diagnostic imaging</topic><topic>Neoplasms - mortality</topic><topic>Original</topic><topic>Preoperative Care - methods</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Statistics, Nonparametric</topic><topic>Survival Analysis</topic><topic>Time Factors</topic><topic>Tomography, X-Ray Computed - methods</topic><topic>Transcatheter Aortic Valve Replacement - methods</topic><topic>Transcatheter Aortic Valve Replacement - mortality</topic><topic>Treatment Outcome</topic><topic>Ultrasonography</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stachon, Peter</creatorcontrib><creatorcontrib>Kaier, Klaus</creatorcontrib><creatorcontrib>Milde, Simone</creatorcontrib><creatorcontrib>Pache, Gregor</creatorcontrib><creatorcontrib>Sorg, Stefan</creatorcontrib><creatorcontrib>Siepe, Matthias</creatorcontrib><creatorcontrib>von zur Mühlen, Constantin</creatorcontrib><creatorcontrib>Zirlik, Andreas</creatorcontrib><creatorcontrib>Beyersdorf, Friedhelm</creatorcontrib><creatorcontrib>Langer, Mathias</creatorcontrib><creatorcontrib>Zehender, Manfred</creatorcontrib><creatorcontrib>Bode, Christoph</creatorcontrib><creatorcontrib>Reinöhl, Jochen</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>European heart journal cardiovascular imaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stachon, Peter</au><au>Kaier, Klaus</au><au>Milde, Simone</au><au>Pache, Gregor</au><au>Sorg, Stefan</au><au>Siepe, Matthias</au><au>von zur Mühlen, Constantin</au><au>Zirlik, Andreas</au><au>Beyersdorf, Friedhelm</au><au>Langer, Mathias</au><au>Zehender, Manfred</au><au>Bode, Christoph</au><au>Reinöhl, Jochen</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Two-year survival of patients screened for transcatheter aortic valve replacement with potentially malignant incidental findings in initial body computed tomography</atitle><jtitle>European heart journal cardiovascular imaging</jtitle><addtitle>Eur Heart J Cardiovasc Imaging</addtitle><date>2015-07-01</date><risdate>2015</risdate><volume>16</volume><issue>7</issue><spage>731</spage><epage>737</epage><pages>731-737</pages><issn>2047-2404</issn><eissn>2047-2412</eissn><abstract>Recently, transcatheter aortic valve replacement (TAVR) has evolved as the standard treatment in patients with inoperable aortic valve stenosis. According to TAVR guidelines, body computed tomography (CT) is recommended for pre-procedural planning. Due to the advanced age of these patients, multiple radiological potentially malignant incidental findings (pmIFs) appear in this cohort. It is unknown how pmIFs influence the decision by the heart team to intervene and the mortality.
We evaluated in a retrospective single-centre observational study 414 participants screened for TAVR with dual-source CT between October 2010 and December 2012. pmIFs are common and appeared in 18.7% of all patients screened for TAVR. The decision to intervene by TAVR or surgical aortic valve replacement (SAVR) was made by an interdisciplinary heart team and the role of pmIF in decision-making and time to treatment with TAVR or SAVR was analysed, retrospectively. The appearance of a pmIF vs. no pmIF did not significantly influence therapeutic decisions [odds ratio (OR) 1.14; P = 0.835] or time to treatment (91 ± 152 vs. 61 ± 109 days, respectively). Several findings, which are highly suspicious for malignancy, were less likely associated with invasive treatment (OR 0.207; P = 0.046). Patient survival was evaluated for at least 2 years until January 2014. Two-year survival of patients after TAVR or SAVR, treated according to the heart team decision, was ∼75% and independent from the presence of a non-severe (P = 0.923) or severe (P = 0.823) pmIF.
The study indicates that frequently occurring radiologic pmIF did not influence 2-year survival after a decision to intervene was made by an interdisciplinary heart team.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>25759083</pmid><doi>10.1093/ehjci/jev055</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aged, 80 and over Aortic Valve Stenosis - diagnostic imaging Aortic Valve Stenosis - epidemiology Aortic Valve Stenosis - surgery Cohort Studies Female Humans Incidental Findings Kaplan-Meier Estimate Male Middle Aged Neoplasms - diagnostic imaging Neoplasms - mortality Original Preoperative Care - methods Prognosis Proportional Hazards Models Retrospective Studies Risk Assessment Statistics, Nonparametric Survival Analysis Time Factors Tomography, X-Ray Computed - methods Transcatheter Aortic Valve Replacement - methods Transcatheter Aortic Valve Replacement - mortality Treatment Outcome Ultrasonography |
| title | Two-year survival of patients screened for transcatheter aortic valve replacement with potentially malignant incidental findings in initial body computed tomography |
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