The aortic valve calcium nodule score (AVCNS) independently predicts paravalvular regurgitation after transcatheter aortic valve replacement (TAVR) |
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| Affiliation: | 1. Cardiac Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA;2. Interventional Cardiology, Heart Center, Massachusetts General Hospital, Boston, MA, USA;3. Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain;4. Interventional Echocardiography, Heart Center, Massachusetts General Hospital, Boston, MA, USA;5. Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX;1. Department of Radiology, Seoul St. Mary''s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 137-701, South Korea;2. Department of Radiology, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, 93, Jungbu-daero, Paldal-gu, Suwon, Gyeonggi-do, 442-723, South Korea;1. Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan;2. Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan;3. Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Gunma, Japan;1. Department of Cardiology, Geisinger Health System, Danville, Pennsylvania;2. Department of Cardiology, Riverside Methodist Hospital, Columbus, Ohio;3. Department of Cardiology, Houston-Methodist-Debakey Heart and Vascular Center, Houston, Texas;4. Department of Cardiothoracic Surgery, Houston-Methodist-Debakey Heart and Vascular Center, Houston, Texase;5. Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, New York;6. Coronary and Structural Heart Department, Statistics, Medtronic, Mounds View, Minnesota;7. Department of Cardiology, Yale University School of Medicine, New Haven, Connecticut;8. Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts;1. Department of Medical Imaging, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada;2. Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada;1. Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan;2. Department of Diagnostic Radiology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan;3. Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan |
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| Abstract: | BackgroundParavalvular regurgitation (PVR) is an important predictor of mortality after transcatheter aortic valve replacement (TAVR). Aortic valve (AV) calcification is strongly associated with PVR.ObjectivesThis study proposes a new metric to quantify AV total calcium burden and its composition in large calcium nodules (CNs) and explores its relation with PVR after TAVR.MethodsIn 133 patients that underwent TAVR, calcium burden of the AV was quantified with multidetector row CT as calcium mass. Each CN was characterized. The AV CN score (AVCNS) was defined as AV calcium mass × mass of the largest CN. PVR was assessed with echocardiography at 1 month. Logistic regression analysis was conducted to identify predictors of PVR.ResultsMean age was 84.1 ± 7.6 years (56% women). TAVR access was transapical in 56%. Procedural success was achieved in 92%. In-hospital mortality was 5%. At follow-up, the prevalence of absent/trace, mild, moderate, and severe PVR was 58%, 31%, 11%, and 0%, respectively. The only independent predictors of at least mild PVR were AVCNS (odds ratio [OR], 2.269; 95% CI, 1.433–3.593; P < .001), number of CNs on aortic annulus (OR, 1.822; 95% CI, 1.137–2.921; P = .013), and aortic annulus area (OR, 1.112; 95% CI, 1.010–1.223; P = .030). This model showed an area under the curve of 0.895 (95% CI, 0.830–0.960) for PVR prediction.ConclusionsAVCNS, a variable that comprises the total burden of AV calcification as well as calcification agglomeration in form of large nodules, is a novel and powerful independent predictor of PVR after TAVR. |
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| Keywords: | Aortic valve Computed tomography Paravalvular regurgitation Transcatheter aortic valve replacement Calcification Calcium |
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