Combining Coronary CTA Features with Clinical Risk Factors to Predict All-cause Mortality in Patients after Transcatheter Aortic Valve Replacement
ZHU He
DENG Yan
WANG Qian
ZHANG Shuo
XU Yiqiang
NIE Pei
Abstract：Objectives:We explored the value of combining coronary computed tomography angiography(CCTA)-derived features with clinical factors to predict all-cause mortality after(transcatheter aortic valve replacement,TAVR).Methods:A total of 380 candidates for CCTA examined between September 2017 and September 2023 were enrolled in this multicenter retrospective cohort study with clinical end point being all-cause mortality.Univariate and multivariate Cox regression analyses were performed to identify independent clinical and CCTA-derived predictors of post-TAVR mortality to construct clinical or imaging factor only models and a combined factor model.Model performance was evaluated using time-dependent area under the receiver operating characteristic curve(time-AUC)and Harrell's concordance index(C-index).To compare nested models,χ2 likelihood ratio analyses were performed.Results:Median follow-up duration was 706 days.All-cause mortality occurred in 13%(48/380)of the patients.The combined model(age+diabetes+coronary artery disease reporting and data system,(CAD-RADS)+(segment stenosis score,SSS)+(left anterior descending artery-fat attenuation index,LAD-FAI))demonstrated superior predictive performance for all-cause mortality with higher C-index(0.690,95%confidence interval[CI]:0.590-0.772)compared with the clinical model(age+diabetes)(C-index,0.630,95%CI:0.538-0.718).Likelihood ratio tests confirmed significantly better fit of the combined model than the clinical model.SHAP analysis indicated that LAD-FAI and age were the most influential factors contributing to model prediction accuracy.Conclusion:A combined model incorporating CCTA features and clinical risk factors can improve all-cause mortality prediction efficacy in patients after TAVR.
Keywords：transcatheter aortic valve replacement/transcatheter aortic valve implantation(TAVR/TAVI)coronary computed tomography angiography(CCTA)fat attenuation index(FAI)coronary artery disease reporting and data system(CAD-RADS)
Publication Date：2026-03-31
Online Publishing Date：2026-04-02(First online date of this platform, not the publication date of the document)
Pages：9( 336-344 )