{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:55:30Z","timestamp":1787072130302,"version":"build-2736575974"},"reference-count":32,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Pericardial effusion is a common finding on pre-procedural computed tomography (CT) in patients undergoing transcatheter aortic valve implantation (TAVI). However, its clinical significance remains uncertain. Using artificial intelligence (AI)-based image analysis, we sought to determine whether pericardial effusion represents an incidental imaging finding, a marker of hemodynamic burden, or a prognostically relevant phenotype. Methods: This retrospective single-center study included 470 consecutive patients undergoing TAVI for severe aortic stenosis. Pericardial effusion volume was quantified using an AI-based CT segmentation workflow and categorized as no effusion (0 mL), trace effusion (&gt;0\u2013&lt;5 mL), small effusion (5\u2013&lt;30 mL), or larger effusion (\u226530 mL). Associations with baseline clinical and echocardiographic characteristics were assessed. Long-term mortality was evaluated using Kaplan\u2013Meier analysis, Cox regression models, and restricted cubic spline analyses. Results: Detectable pericardial effusion was present in 276 patients (58.7%), although larger effusions were uncommon (5.1%). Increasing pericardial effusion volume was associated with a higher prevalence of atrial fibrillation (p = 0.001), higher systolic pulmonary artery pressure (p = 0.004), and lower TAPSE\/sPAP ratios (p = 0.007). In contrast, left ventricular ejection fraction and transvalvular gradients did not differ across effusion categories. During long-term follow-up, no significant differences in mortality were observed between pericardial effusion groups (log-rank p = 0.46). Pericardial effusion volume was not associated with mortality when analyzed as a continuous variable (HR 1.00, 95% CI 0.996\u20131.01; p = 0.842), after logarithmic transformation (adjusted HR 0.91, 95% CI 0.76\u20131.08; p = 0.293), or in restricted cubic spline analyses. Conclusions: AI-derived pericardial effusion volume identifies a hemodynamic phenotype characterized by atrial fibrillation, pulmonary hypertension, and impaired right ventricular\u2013pulmonary arterial coupling. Despite these associations, pericardial effusion volume does not independently predict long-term mortality after TAVI, suggesting that it reflects cardiovascular congestion and remodeling rather than a prognostically relevant phenotype.<\/jats:p>","DOI":"10.3390\/jcm15166388","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:12:11Z","timestamp":1787069531000},"page":"6388","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["AI-Derived Pericardial Effusion Volume and Long-Term Mortality After Transcatheter Aortic Valve Implantation"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-3263-372X","authenticated-orcid":false,"given":"Gretha","family":"Hecke","sequence":"first","affiliation":[{"name":"Department of Radiology, Paracelsus Medical University, 5020 Salzburg, Austria"},{"name":"Division of Cardiology, Department of Internal Medicine II, Paracelsus Medical University, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3443-9943","authenticated-orcid":false,"given":"Nikolaus","family":"Clodi","sequence":"additional","affiliation":[{"name":"Department of Radiology, Paracelsus Medical University, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Scharinger","sequence":"additional","affiliation":[{"name":"Department of Radiology, Paracelsus Medical University, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Hammerer","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine II, Paracelsus Medical University, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7352-1987","authenticated-orcid":false,"given":"Laura","family":"Preuss","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine II, Paracelsus Medical University, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uta C.","family":"Hoppe","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine II, Paracelsus Medical University, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6571-8296","authenticated-orcid":false,"given":"Klaus","family":"Hergan","sequence":"additional","affiliation":[{"name":"Department of Radiology, Paracelsus Medical University, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6589-3853","authenticated-orcid":false,"given":"Elke","family":"Boxhammer","sequence":"additional","affiliation":[{"name":"Department of Radiology, Paracelsus Medical University, 5020 Salzburg, Austria"},{"name":"Division of Cardiology, Department of Internal Medicine II, Paracelsus Medical University, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0656-7038","authenticated-orcid":false,"given":"Christoph","family":"Knapitsch","sequence":"additional","affiliation":[{"name":"Department of Radiology, Paracelsus Medical University, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Sch\u00f6rghofer","sequence":"additional","affiliation":[{"name":"Department of Radiology, Paracelsus Medical University, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/s10554-014-0520-y","article-title":"Pericardial effusion following transcatheter aortic valve implantation: Echocardiography and multi-detector row computed tomography evaluation","volume":"31","author":"Katsanos","year":"2015","journal-title":"Int. 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