Impact of pulmonary-artery-to-aorta ratio on clinical outcomes in patients undergoing transcatheter aortic valve implantation: A retrospective study.

ObjectivePulmonary-to-aortic diameter ratio (P/A) correlates with pulmonary hypertension (PH), which is linked to adverse outcomes. Our aim was to evaluate the impact of the P/A ratio, measured using computed tomography (CT), on adverse postoperative outcomes in patients undergoing transcatheter aortic valve implantation (TAVI).MethodsThis study included 387 patients with aortic valve disease who underwent TAVI between January 2018 and June 2024. The clinical endpoint was the composite outcome of all-cause mortality and postoperative hospitalization for heart failure. The cut-off value for the P/A ratio was obtained by analyzing the receiver operating characteristic (ROC) curve. Cox proportional hazards models were used to examine the association between the P/A ratio and the composite outcome, with subsequent subgroup and sensitivity analyses.ResultsThe median follow-up time was 19 months [interquartile range (IQR): 1.00-59.0], and a composite outcome occurred in 14% of patients in this study. A P/A ratio of 0.84 was identified as the optimal cut-off value. Compared with the low P/A group, the high P/A group had a higher proportion of females and patients with diabetes, higher triglyceride levels, and higher systolic pulmonary artery pressure (sPAP) levels. Multivariable Cox analysis confirmed that a high P/A ratio [hazard ratio (HR): 1.96, 95% confidence interval (CI): 1.03-3.72; p = 0.04] was associated with the composite outcome. Subgroup and sensitivity analyses yielded consistent results.ConclusionsThe P/A ratio measured using CT may serve as a novel prognostic factor in patients undergoing TAVI. A high P/A ratio (≥ 0.84) is an independent risk factor for the composite outcome.