Imaging and biomarker-based risk stratification in TAVI: the role of epicardial fat, visceral fat, and adiponectin.
Authors
Affiliations (4)
Affiliations (4)
- Cardiovascular Center Aalst, Moorselbaan 164, Aalst 9300, Belgium.
- Department of Prevention and Treatment of Emergency Conditions, L.T. Malaya Therapy National Institute NAMSU, 2a Lyubovi Maloy Avenue, Kharkiv 61039, Ukraine.
- Department of Clinical and Molecular Medicine, Sapienza University, Via Giorgio Nicola Papanicolau, Rome 00189, Italy.
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini 5, Naples 80131, Italy.
Abstract
Transcatheter aortic valve implantation (TAVI) has become a standard treatment for severe aortic stenosis, yet clinical outcomes vary significantly. Epicardial adipose tissue (EAT), visceral adipose tissue (VAT), and circulating adiponectin may contribute to this heterogeneity. This study aimed to determine how adipose tissue characteristics, in combination with adiponectin levels, affect clinical outcomes following TAVI. This single-centre retrospective study included 243 patients with severe aortic stenosis who underwent TAVI. Pre-procedural computed tomography scans were processed using artificial intelligence to quantify EAT density (EAT<sub>HU</sub>) and VAT area at the level of the L3 vertebra (VAT<sub>L3A</sub>). Patients were stratified into groups based on median adiponectin (6.54 µg/mL), VAT<sub>L3A</sub> (135 mm), EAT<sub>HU</sub> (-82.0 HU), and EAT<sub>VOL</sub> (31 mL). The primary endpoint was 1-year major adverse cardiac and cerebrovascular events (MACCE), defined as all-cause mortality, heart failure hospitalization, or stroke. Over a mean follow-up of 344 ± 77 days, there were 25 deaths (10%), 12 heart failure hospitalizations (5%), and 7 strokes (3%). Circulating adiponectin (adjusted HR 1.34 per 5 μg/mL, 95% CI 1.05-1.70; <i>P</i> = 0.017) and VAT<sub>L3A</sub> (adjusted HR 0.63 per 100 mm<sup>2</sup>, 95% CI 0.44-0.91; <i>P</i> = 0.014) independently associated with MACCE, EAT<sub>HU</sub>, and EAT<sub>VOL</sub> did not. All three combined adipose-adiponectin phenotypes demonstrated significant graded risk (<i>P</i>-for-trend 0.003-0.048), with the high EAT<sub>VOL</sub>/high adiponectin phenotype showing the strongest association (adjusted HR 4.25, 95% CI 1.80-10.07). Circulating adiponectin and VAT<sub>L3A</sub> independently predict 1-year MACCE after TAVI. EAT parameters become prognostically informative only when combined with adiponectin.