Background: In acute pulmonary embolism (PE), abrupt right ventricular (RV) pressure overload and ventricular interdependence are primary determinants of hemodynamic deterioration and short-term mortality. Conventional computedtomographic pulmonary angiography (CTPA) markers, such as the RV/left ventricular (LV) diameter ratio, exhibit variable prognostic performance and may not fully capture early geometric remodeling. It was hypothesized that CTPA-derived apical angle metrics, reflecting biventricular geometric distortion, provide complementary prognostic information beyond established clinical scores. Methods: In this retrospective study of 535 consecutive patients with acute PE, novel CTPA-derived apical geometry metrics were evaluated: the RV apical angle (alpha 1), the LV apical angle (alpha 2), and their ratio (alpha 1/ alpha alpha 2 alpha 2). The primary outcome was in-hospital mortality; long-term all-cause mortality served asthe secondary outcome. Results: Higher alpha alpha 1 and alpha 1/alpha 2 values were significantly associated with greater pulmonary arterial obstruction, severe RV dysfunction, and higher clinical risk status. In-hospital mortality increased significantly across alpha alpha 1 alpha 1tertiles (P = .017). In multiple logistic regression models, after adjustmentforthe Pulmonary Embolism Severity Index (PESI) score and the conventional RV/LV diameter ratio, both alpha alpha 1 and alpha 1/alpha 2 remained independently associated with in-hospital mortality. Adding these apical metricsto the PESI-based baseline model significantly improved prognostic accuracy, demonstrating substantial incremental value for short-term risk stratification. Mortality risk increased linearly beyond thresholds of alpha alpha 1 > 32.5 degrees and alpha alpha 1 alpha 1/ alpha 1/alpha 2> alpha 1/alpha 2>1.17. In multiple Cox proportional hazards analysis, no imaging-derived parameter independently predicted long-term mortality. Conclusions: Computed tomographic pulmonary angiography-derived apical angle metrics provide physiologically meaningful, continuous measures of acute RV geometric remodeling in acute PE. These metrics offer significant incremental prognostic value for in-hospital mortality beyond the PESI score and conventional CT markers.
Background: As transcatheter aortic valve implantation (TAVI) has become a standard treatment for severe aortic stenosis, the optimal anesthetic strategy remains debated. In addition to anesthesia choice, institutional experience may influence procedural efficiency and outcomes; however, their interplay remains unclear. This study aimed to evaluate the association between anesthetic strategy and outcomes after elective transfemoral TAVI and to assess whether these associations are modified by institutional experience. Methods: In this retrospective observational study, consecutive patients undergoing elective transfemoral TAVI at a high-volume tertiary center between 2020 and 2025 were analyzed. To reduce selection bias, inverse probability weighting with double-robust outcome modeling was applied. The primary outcome was intensive care unit (ICU) stay duration, and in-hospital mortality was evaluated as a secondary outcome. Institutional experience was modeled as chronological case sequence, with an interaction term to assess effect modification. Results: A total of 852 patients were included. After weighting, baseline characteristics were well balanced between conscious sedation (CS) and general anesthesia (GA) groups. General anesthesia utilization decreased from 71% in 2020 to 13% in 2025. Conscious sedation was associated with shorter ICU stay compared with GA (21.0 vs. 23.0 hours; P < .001). In adjusted analysis, GA remained independently associated with longer ICU stay (rate ratios = 1.46, P < .001, 95% CI: 1.28-1.66). Anesthetic strategy was not associated with in-hospital mortality (OR = 1.14, P = .667, 95% CI: 0.62-2.10), and no significant interaction with case sequence was observed. Conclusion: Conscious sedation was associated with shorter ICU stay, while no significant differences were observed in mortality outcomes.
Background: Classical low-flow low-gradient aortic stenosis (cLFLG AS) is associated with poor prognosis and adverse clinical outcomes despite transcatheter aortic valve implantation (TAVI). Identifying prognostic markers in this high-risk population may improve risk stratification and clinical management. This study aimed to investigate independent predictors of all-cause mortality in patients with cLFLG AS undergoing TAVI. Methods: In this single-center retrospective study, 151 patients with cLFLG AS undergoing TAVI between January 2018 and December 2024 were included. Multivariable Cox proportional hazards regression analysis was performed to identify predictors of all-cause mortality. Two separate multivariable models incorporating tricuspid annular plane systolic excursion (TAPSE) and TAPSE/systolic pulmonary artery pressure (sPAP) ratio were constructed to evaluate the prognostic impact of right ventricular (RV) systolic function and RV-pulmonary vascular interaction. The prognostic performance of TAPSE was further assessed using receiver operating characteristic (ROC) and restricted cubic spline analyses. Results: During a median follow-up of 26 (15-42) months, all-cause mortality occurred in 37 (25%) patients. In multivariable analysis, reduced TAPSE remained independently associated with all-cause mortality after adjustment for age and left ventricular ejection fraction (LVEF) (HR: 0.11, 95% CI: 0.04-0.30, P < .001). A lower TAPSE/sPAP ratio was also independently associated with mortality (HR: 0.08, 95% CI: 0.01-0.85, P = .036). Advanced age and reduced LVEF were independently associated with mortality in both models. Time-dependent ROC analysis demonstrated consistent discriminative performance of TAPSE over time. Conclusion: Reduced TAPSE, advanced age, and reduced LVEF were independent predictors of all-cause mortality in patients with cLFLG AS undergoing TAVI.
