Interstitial lung abnormality is prevalent and associated with worse outcome in patients undergoing transcatheter aortic valve replacement

Michael A Kadoch, Aleksandar Kitich, Shehabaldin Alqalyoobi, Elyse Lafond, Elena Foster, Maya Juarez, Cesar Mendez, Thomas W R Smith, Garrett B Wong, Walter D Boyd, Jeffrey Southard, Justin Oldham

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Interstitial lung abnormality (ILA) is found in 5–10% of the general population and is associated with increased mortality risk. Risk factors for ILA, including advanced age and smoking history also increase the risk for aortic stenosis (AS). Transcatheter aortic valve replacement (TAVR) has become an increasingly utilized intervention for patients with severe AS, and requires a high-resolution computed tomography (HRCT) of the chest to assess aortic valve dimensions. Objectives: To determine the prevalence and clinical significance of ILA on HRCT performed in patients referred for TAVR. Methods: Consecutive pre-TAVR HRCTs performed over a 5-year period were reviewed. ILA was defined as bilateral, nondependent reticular opacities. All-cause mortality among TAVR recipients was compared between ILA cases and non-ILA controls matched 2:1 by age and gender using Cox proportional hazards regression and the Kaplan Meier estimator. Results: Of 623 HRCTs screened, ILA was detected in 92 (14.7%), including 62 patients that underwent TAVR. Among ILA cases, 17 (27.4%) had a typical or probable usual interstitial pneumonia pattern, suggesting a diagnosis of idiopathic pulmonary fibrosis. Survival was worse in ILA cases compared to non-ILA controls (p = 0.008) and ILA was an independent predictor of mortality after multivariable adjustment (HR 3.29, 95% CI 1.34–8.08; p = 0.009). Conclusions: ILA is a common finding among patients with severe AS and is associated with increased mortality in those undergoing TAVR. Further research is needed to elucidate the biology underpinning this observation and determine whether ILA evaluation and risk stratification modulates this mortality risk.

Original languageEnglish (US)
Pages (from-to)55-60
Number of pages6
JournalRespiratory Medicine
Volume137
DOIs
StatePublished - Apr 1 2018

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Lung
Aortic Valve Stenosis
Mortality
Idiopathic Pulmonary Fibrosis
Transcatheter Aortic Valve Replacement
Tomography
Social Adjustment
Aortic Valve
Thorax
Smoking
History
Survival
Research
Population

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Interstitial lung abnormality is prevalent and associated with worse outcome in patients undergoing transcatheter aortic valve replacement. / Kadoch, Michael A; Kitich, Aleksandar; Alqalyoobi, Shehabaldin; Lafond, Elyse; Foster, Elena; Juarez, Maya; Mendez, Cesar; Smith, Thomas W R; Wong, Garrett B; Boyd, Walter D; Southard, Jeffrey; Oldham, Justin.

In: Respiratory Medicine, Vol. 137, 01.04.2018, p. 55-60.

Research output: Contribution to journalArticle

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title = "Interstitial lung abnormality is prevalent and associated with worse outcome in patients undergoing transcatheter aortic valve replacement",
abstract = "Background: Interstitial lung abnormality (ILA) is found in 5–10{\%} of the general population and is associated with increased mortality risk. Risk factors for ILA, including advanced age and smoking history also increase the risk for aortic stenosis (AS). Transcatheter aortic valve replacement (TAVR) has become an increasingly utilized intervention for patients with severe AS, and requires a high-resolution computed tomography (HRCT) of the chest to assess aortic valve dimensions. Objectives: To determine the prevalence and clinical significance of ILA on HRCT performed in patients referred for TAVR. Methods: Consecutive pre-TAVR HRCTs performed over a 5-year period were reviewed. ILA was defined as bilateral, nondependent reticular opacities. All-cause mortality among TAVR recipients was compared between ILA cases and non-ILA controls matched 2:1 by age and gender using Cox proportional hazards regression and the Kaplan Meier estimator. Results: Of 623 HRCTs screened, ILA was detected in 92 (14.7{\%}), including 62 patients that underwent TAVR. Among ILA cases, 17 (27.4{\%}) had a typical or probable usual interstitial pneumonia pattern, suggesting a diagnosis of idiopathic pulmonary fibrosis. Survival was worse in ILA cases compared to non-ILA controls (p = 0.008) and ILA was an independent predictor of mortality after multivariable adjustment (HR 3.29, 95{\%} CI 1.34–8.08; p = 0.009). Conclusions: ILA is a common finding among patients with severe AS and is associated with increased mortality in those undergoing TAVR. Further research is needed to elucidate the biology underpinning this observation and determine whether ILA evaluation and risk stratification modulates this mortality risk.",
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T1 - Interstitial lung abnormality is prevalent and associated with worse outcome in patients undergoing transcatheter aortic valve replacement

AU - Kadoch, Michael A

AU - Kitich, Aleksandar

AU - Alqalyoobi, Shehabaldin

AU - Lafond, Elyse

AU - Foster, Elena

AU - Juarez, Maya

AU - Mendez, Cesar

AU - Smith, Thomas W R

AU - Wong, Garrett B

AU - Boyd, Walter D

AU - Southard, Jeffrey

AU - Oldham, Justin

PY - 2018/4/1

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N2 - Background: Interstitial lung abnormality (ILA) is found in 5–10% of the general population and is associated with increased mortality risk. Risk factors for ILA, including advanced age and smoking history also increase the risk for aortic stenosis (AS). Transcatheter aortic valve replacement (TAVR) has become an increasingly utilized intervention for patients with severe AS, and requires a high-resolution computed tomography (HRCT) of the chest to assess aortic valve dimensions. Objectives: To determine the prevalence and clinical significance of ILA on HRCT performed in patients referred for TAVR. Methods: Consecutive pre-TAVR HRCTs performed over a 5-year period were reviewed. ILA was defined as bilateral, nondependent reticular opacities. All-cause mortality among TAVR recipients was compared between ILA cases and non-ILA controls matched 2:1 by age and gender using Cox proportional hazards regression and the Kaplan Meier estimator. Results: Of 623 HRCTs screened, ILA was detected in 92 (14.7%), including 62 patients that underwent TAVR. Among ILA cases, 17 (27.4%) had a typical or probable usual interstitial pneumonia pattern, suggesting a diagnosis of idiopathic pulmonary fibrosis. Survival was worse in ILA cases compared to non-ILA controls (p = 0.008) and ILA was an independent predictor of mortality after multivariable adjustment (HR 3.29, 95% CI 1.34–8.08; p = 0.009). Conclusions: ILA is a common finding among patients with severe AS and is associated with increased mortality in those undergoing TAVR. Further research is needed to elucidate the biology underpinning this observation and determine whether ILA evaluation and risk stratification modulates this mortality risk.

AB - Background: Interstitial lung abnormality (ILA) is found in 5–10% of the general population and is associated with increased mortality risk. Risk factors for ILA, including advanced age and smoking history also increase the risk for aortic stenosis (AS). Transcatheter aortic valve replacement (TAVR) has become an increasingly utilized intervention for patients with severe AS, and requires a high-resolution computed tomography (HRCT) of the chest to assess aortic valve dimensions. Objectives: To determine the prevalence and clinical significance of ILA on HRCT performed in patients referred for TAVR. Methods: Consecutive pre-TAVR HRCTs performed over a 5-year period were reviewed. ILA was defined as bilateral, nondependent reticular opacities. All-cause mortality among TAVR recipients was compared between ILA cases and non-ILA controls matched 2:1 by age and gender using Cox proportional hazards regression and the Kaplan Meier estimator. Results: Of 623 HRCTs screened, ILA was detected in 92 (14.7%), including 62 patients that underwent TAVR. Among ILA cases, 17 (27.4%) had a typical or probable usual interstitial pneumonia pattern, suggesting a diagnosis of idiopathic pulmonary fibrosis. Survival was worse in ILA cases compared to non-ILA controls (p = 0.008) and ILA was an independent predictor of mortality after multivariable adjustment (HR 3.29, 95% CI 1.34–8.08; p = 0.009). Conclusions: ILA is a common finding among patients with severe AS and is associated with increased mortality in those undergoing TAVR. Further research is needed to elucidate the biology underpinning this observation and determine whether ILA evaluation and risk stratification modulates this mortality risk.

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