Prevalence and Clinical Impact of Incidental Extracardiovascular Findings in Pre-TAVI CT Imaging

<b>Objectives:</b> To evaluate the prevalence, classification, and clinical relevance of incidental extracardiovascular findings in pre-transcatheter aortic valve implantation (TAVI) CT imaging. <b>Methods:</b> We conducted a retrospective single-center study of 225 patients undergoing pre-TAVI contrast-enhanced, ECG-gated CT scans between 2021 and 2023. Extracardiovascular findings were recorded and categorized into three groups based on presumed clinical relevance: Group A (findings with no need for follow-up), Group B (findings requiring follow-up), and Group C (findings requiring immediate intervention or treatment). Statistical analysis included a descriptive assessment of the overall prevalence of incidental findings and evaluation of age- and sex-related trends using chi-square tests with Bonferroni-adjusted pairwise comparisons. <b>Results:</b> The study cohort included 225 patients (53.3% male; mean age 79.9 ± 6.2 years, range 58-93). Extracardiovascular incidental findings were detected in 205 patients (91.1%). Among all 478 recorded findings, 82.6% were Group A, 14.4% Group B, and 2.9% Group C. On a per-patient level, 87.1% had at least one Group A finding, 24.9% had at least one Group B, and 6.2% had at least one Group C finding. Older age was associated with more incidental findings, with a significant difference observed between the 70-79 and 80-89 age groups (<i>p</i> = 0.002). No significant sex-related differences were found (<i>p</i> = 0.226). Findings were most frequently located in the abdomen (46.2%) and thorax (37.2%). Among all clinically relevant findings, the thorax was the most commonly affected region: 43.5% of Group B and 78.6% of Group C findings were located in the thorax, followed by the abdomen (33.3% of Group B and 7.1% of Group C findings). <b>Conclusions:</b> Extracardiovascular incidental findings are highly prevalent in pre-TAVI CT imaging and range from benign, age-related changes to potentially serious conditions such as malignancies or infections. Their presence reflects the comorbidity burden of the typical TAVI population and underscores the importance of recognizing non-vascular incidental findings in this clinical setting.