European Radiology

, Volume 29, Issue 2, pp 975–984 | Cite as

Pre-procedural CT angiography inferior vena cava measurements: a predictor of mortality in patients undergoing transcatheter aortic valve implantation

  • Matthias EberhardEmail author
  • Gianluca Milanese
  • Michael Ho
  • Stefan Zimmermann
  • Thomas Frauenfelder
  • Fabian Nietlispach
  • Francesco Maisano
  • Felix C. Tanner
  • Thi Dan Linh Nguyen-Kim



To assess the value of pre-procedural computed tomography angiography (CTA) measurements of the suprahepatic inferior vena cava (IVC) to detect elevated central venous pressure (CVP) assessed by right heart catheterisation (RHC), and to predict post-procedural 1-year mortality in a cohort of patients undergoing transcatheter aortic valve implantation (TAVI).


We retrospectively evaluated 408 consecutive patients undergoing CTA before TAVI between January 2011 and December 2014. Two hundred and five patients were included in the RHC cohort, who underwent RHC and CTA within ≤1 day prior to TAVI. Two hundred and three patients not fulfilling this requirement were included in the validation cohort. Measurements of the IVC were performed between diaphragm and right atrium on axial slices. Receiver operating characteristic (ROC) analyses, Kaplan-Meier analyses and Cox regression analyses were performed.


In the RHC cohort, ROC curve analyses for IVC area measurements indicated an AUC of 0.77 (p < 0.001) to detect CVP ≥10mmHg and an area under the ROC curve (AUC) of 0.72 (p < 0.001) to predict 1-year mortality. An IVC area cut-off of ≥665 mm2 predicted 1-year mortality with a specificity of 84% and a sensitivity of 63%. Kaplan-Meier analysis showed that patients with an IVC area ≥665 mm2 had a significantly higher post-procedural 1-year mortality (38% versus 7%, log-rank p < 0.001) with a hazard ratio of 5.5 (95% CI, 2.2-13.6; p < 0.001). Applying this cut-off value to the validation cohort confirmed a significantly higher 1-year mortality after TAVI (34% versus 11%; log-rank p = 0.004) for patients with an IVC area ≥665 mm2.


Pre-procedural enlargement of the suprahepatic IVC is a predictor of post-procedural 1-year mortality in patients evaluated for TAVI.

Key Points

• IVC measurements are moderate predictors of an elevated CVP in TAVI patients.

• Pre-procedural IVC enlargement is a predictor of 1-year mortality after TAVI.

• IVC enlargement is associated with right heart dysfunction in TAVI patients.


Aortic valve stenosis Central venous pressure Computed tomography angiography Vena cava; inferior Transcatheter aortic valve replacement 



Body surface area


Central venous pressure


Inferior vena cava


Pulmonary capillary wedge pressure


Right heart catheterisation


Transcatheter aortic valve implantation



We thank Gillian von Rechenberg for language and punctuation revision of our manuscript.


The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Thi Dan Linh Nguyen-Kim.

Conflict of interest

The authors of this manuscript declare relationships with the following companies:

Francesco Maisano is consultant for Abbott Vascular, St Jude Medical, Medtronic, ValtechCardio and receives royalties from Edwards Lifesciences.

Fabian Nietlispach is consultant for Edwards Lifesciences, Medtronic, St Jude Medical.

Thi Dan Linh Nguyen-Kim is funded by the research grant “Filling the gap” from the University of Zurich, Switzerland.

All other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in:

1. Eberhard M, Mastalerz M, Frauenfelder T et al (2017) Quantification of aortic valve calcification on contrast-enhanced CT of patients prior to transcatheter aortic valve implantation. EuroIntervention 13:921-927

2. Eberhard M, Mastalerz M, Pavicevic J et al (2017) Value of CT signs and measurements as a predictor of pulmonary hypertension and mortality in symptomatic severe aortic valve stenosis. Int J Cardiovasc Imaging 33:1637-1651

3. Possner M, Vontobel J, Nguyen-Kim TD et al (2016) Prognostic value of aortic regurgitation after AVI in patients with chronic kidney disease. Int J Cardiol 221:180-187

4. Stahli BE, Abouelnour A, Nguyen TD et al (2014) Impact of three-dimensional imaging and pressure recovery on echocardiographic evaluation of severe aortic stenosis: a pilot study. Echocardiography 31:1006-1016

While the previous studies assessed quantification of aortic valve calcification, prognostic value of aortic regurgitation after TAVI, impact of three-dimensional imaging and pressure recovery on echocardiographic evaluation of severe aortic stenosis and value of previously reported CT signs and measurements as a predictor of pulmonary hypertension and mortality in severe aortic stenosis, this work focused on whether IVC measurements are correlated with central venous pressure and the predictive value of IVC measurements on one-year mortality after TAVI. Thus, this work is substantially different from the previous reports. Additionally, in contrast to the aforementioned studies the present study is the only one including all patients undergoing TAVI between 01/2011 and 12/2014 at our institution.


• retrospective

• diagnostic or prognostic study

• performed at one institution


  1. 1.
    Joint Task Force on the Management of Valvular Heart Disease of the European Society of C, European Association for Cardio-Thoracic S, Vahanian A et al (2012) Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 33:2451–2496CrossRefGoogle Scholar
  2. 2.
    Neely RC, Leacche M, Gosev I, Kaneko T, Byrne JG, Davidson MJ (2014) The 2014 American Heart Association/American College of Cardiology guideline for the management of patients with valvular heart disease: a changing landscape. J Thorac Cardiovasc Surg 148:5–6CrossRefGoogle Scholar
  3. 3.
    Nishimura RA, Otto CM, Bonow RO et al (2014) 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 129:2440–2492CrossRefGoogle Scholar
  4. 4.
    Young MN, Inglessis I (2017) Transcatheter aortic valve replacement: outcomes, indications, complications. and innovations. Curr Treat Options Cardiovasc Med 19:81CrossRefGoogle Scholar
  5. 5.
    Storz C, Geisler T, Notohamiprodjo M, Nikolaou K, Bamberg F (2016) Role of imaging in transcatheter aortic valve replacement. Curr Treat Options Cardiovasc Med 18:59CrossRefGoogle Scholar
  6. 6.
    Eberhard M, Mastalerz M, Frauenfelder T et al (2017) Quantification of aortic valve calcification on contrast-enhanced CT of patients prior to transcatheter aortic valve implantation. EuroIntervention 13:921–927CrossRefGoogle Scholar
  7. 7.
    Jurencak T, Turek J, Kietselaer BL et al (2015) MDCT evaluation of aortic root and aortic valve prior to TAVI. What is the optimal imaging time point in the cardiac cycle? Eur Radiol 25:1975–1983CrossRefGoogle Scholar
  8. 8.
    Felmly LM, De Cecco CN, Schoepf UJ et al (2017) Low contrast medium-volume third-generation dual-source computed tomography angiography for transcatheter aortic valve replacement planning. Eur Radiol 27:1944–1953CrossRefGoogle Scholar
  9. 9.
    Kjaergaard J, Akkan D, Iversen KK, Kober L, Torp-Pedersen C, Hassager C (2007) Right ventricular dysfunction as an independent predictor of short- and long-term mortality in patients with heart failure. Eur J Heart Fail 9:610–616CrossRefGoogle Scholar
  10. 10.
    Mohammed SF, Hussain I, AbouEzzeddine OF et al (2014) Right ventricular function in heart failure with preserved ejection fraction: a community-based study. Circulation 130:2310–2320CrossRefGoogle Scholar
  11. 11.
    Testa L, Latib A, De Marco F et al (2016) The failing right heart: implications and evolution in high-risk patients undergoing transcatheter aortic valve implantation. EuroIntervention 12:1542–1549CrossRefGoogle Scholar
  12. 12.
    Skali H, Zornoff LA, Pfeffer MA et al (2005) Prognostic use of echocardiography 1 year after a myocardial infarction. Am Heart J 150:743–749CrossRefGoogle Scholar
  13. 13.
    Di Salvo TG, Mathier M, Semigran MJ, Dec GW (1995) Preserved right ventricular ejection fraction predicts exercise capacity and survival in advanced heart failure. J Am Coll Cardiol 25:1143–1153CrossRefGoogle Scholar
  14. 14.
    Kammerlander AA, Marzluf BA, Graf A et al (2014) Right ventricular dysfunction, but not tricuspid regurgitation, is associated with outcome late after left heart valve procedure. J Am Coll Cardiol 64:2633–2642CrossRefGoogle Scholar
  15. 15.
    Eberhard M, Mastalerz M, Pavicevic J et al (2017) Value of CT signs and measurements as a predictor of pulmonary hypertension and mortality in symptomatic severe aortic valve stenosis. Int J Cardiovasc Imaging 33:1637–1651CrossRefGoogle Scholar
  16. 16.
    Lang RM, Badano LP, Mor-Avi V et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28:1–39.e14CrossRefGoogle Scholar
  17. 17.
    Rudski LG, Lai WW, Afilalo J et al (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 23:685–713 quiz 786-688CrossRefGoogle Scholar
  18. 18.
    Beigel R, Cercek B, Luo H, Siegel RJ (2013) Noninvasive evaluation of right atrial pressure. J Am Soc Echocardiogr 26:1033–1042CrossRefGoogle Scholar
  19. 19.
    Ciozda W, Kedan I, Kehl DW, Zimmer R, Khandwalla R, Kimchi A (2016) The efficacy of sonographic measurement of inferior vena cava diameter as an estimate of central venous pressure. Cardiovasc Ultrasound 14:33CrossRefGoogle Scholar
  20. 20.
    Seo Y, Iida N, Yamamoto M, Machino-Ohtsuka T, Ishizu T, Aonuma K (2017) Estimation of central venous pressure using the ratio of short to long diameter from cross-sectional images of the inferior vena cava. J Am Soc Echocardiogr 30:461–467CrossRefGoogle Scholar
  21. 21.
    Ben-Dor I, Goldstein SA, Pichard AD et al (2011) Clinical profile, prognostic implication, and response to treatment of pulmonary hypertension in patients with severe aortic stenosis. Am J Cardiol 107:1046–1051CrossRefGoogle Scholar
  22. 22.
    Khush KK, Tasissa G, Butler J, McGlothlin D, De Marco T, Investigators E (2009) Effect of pulmonary hypertension on clinical outcomes in advanced heart failure: analysis of the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) database. Am Heart J 157:1026–1034CrossRefGoogle Scholar
  23. 23.
    Baggen VJ, Leiner T, Post MC et al (2016) Cardiac magnetic resonance findings predicting mortality in patients with pulmonary arterial hypertension: a systematic review and meta-analysis. Eur Radiol 26:3771–3780CrossRefGoogle Scholar
  24. 24.
    O'Sullivan CJ, Wenaweser P, Ceylan O et al (2015) Effect of pulmonary hypertension haemodynamic presentation on clinical outcomes in patients with severe symptomatic aortic valve stenosis undergoing transcatheter aortic valve implantation: insights from the new proposed pulmonary hypertension classification. Circ Cardiovasc Interv 8:e002358Google Scholar
  25. 25.
    Chrissoheris M, Ziakas A, Chalapas A et al (2016) Acute invasive haemodynamic effects of transcatheter aortic valve replacement. J Heart Valve Dis 25:162–172Google Scholar
  26. 26.
    Benza RL, Miller DP, Gomberg-Maitland M et al (2010) Predicting survival in pulmonary arterial hypertension: insights from the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL). Circulation 122:164–172CrossRefGoogle Scholar
  27. 27.
    Koifman E, Didier R, Patel N et al (2017) Impact of right ventricular function on outcome of severe aortic stenosis patients undergoing transcatheter aortic valve replacement. Am Heart J 184:141–147CrossRefGoogle Scholar
  28. 28.
    Franzone A, O'Sullivan CJ, Stortecky S et al (2017) Prognostic impact of invasive haemodynamic measurements in combination with clinical and echocardiographic characteristics on two-year clinical outcomes of patients undergoing transcatheter aortic valve implantation. EuroIntervention 12:e2186–e2193CrossRefGoogle Scholar
  29. 29.
    Natori H, Tamaki S, Kira S (1979) Ultrasonographic evaluation of ventilatory effect on inferior vena caval configuration. Am Rev Respir Dis 120:421–427Google Scholar

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Matthias Eberhard
    • 1
    Email author
  • Gianluca Milanese
    • 2
  • Michael Ho
    • 1
  • Stefan Zimmermann
    • 3
  • Thomas Frauenfelder
    • 1
  • Fabian Nietlispach
    • 3
  • Francesco Maisano
    • 3
  • Felix C. Tanner
    • 3
  • Thi Dan Linh Nguyen-Kim
    • 1
  1. 1.Institute of Diagnostic and Interventional RadiologyUniversity Hospital ZurichZurichSwitzerland
  2. 2.Division of Radiology, Department of Medicine and Surgery (DiMeC)University of ParmaParmaItaly
  3. 3.University Heart Centre ZurichZurichSwitzerland

Personalised recommendations