A new calcium score to predict paravalvular leak in transcatheter aortic valve implantation

Abstract

OBJECTIVES The present study sought to develop a reliable calcium score (Ca-score) to predict paravalvular leak (PVL) in patients undergoing transcatheter aortic valve (AV) implantation. METHODS A total of 965 patients were prospectively included from 2012 to 2019. Preprocedural contrast-media-enhanced computed tomography scans were analysed regarding the amount of AV cusp calcification and the presence of upper and lower left ventricular outflow tract calcification. The calcium volume threshold of each AV cusp [non-coronary cusp (NCC); left coronary cusp (LCC); right coronary cusp (RCC)] with optimal PVL prediction was defined using the Youden index value derived from receiver operating characteristic analysis. The final score was developed based on the multivariable regression analysis, while individual variables were weighted based on their corresponding odds ratio. RESULTS The AV calcium volume threshold with optimal PVL prediction was 733.6, 296.0 and 131.2 mm3 for the NCC, RCC and LCC respectively. Overall, calcification of the upper left ventricular outflow tract was present in 233 (23%), 111 (12%) and 304 (32%) of patients below the NCC, RCC and LCC respectively, while 260 (27%), 44 (5%) and 217 (23%) patients suffered from calcification under the NCC, RCC and LCC, respectively. A total Ca-score of ≥4 was present in 356 (37%) of patients and was independently associated with ≥ mild PVL [odds ratio 3.662; 95% confidence interval (2.740–4.911); P < 0.001]. The area under the curve of the Ca-score was 0.713 [95% confidence interval (0.678–0.748); P < 0.001]. CONCLUSION The provided Ca-score independently correlates with the development of PVL and improves risk stratification in patients undergoing transcatheter AV implantation.

Echocardiographic parameters associated with less reverse left ventricular remodeling after transcatheter aortic valve implant in subjects with prosthesis patient mismatch

“…While, echocardiography is indispensable for the assessment of aortic stenosis pre‐TAVI and for long‐term monitoring of prosthetic valve function post‐procedure, cardiac CT is the modality of choice for pre‐procedural planning and device sizing. Severe calcification of the LVOT identified on CT are associated with increased risk of paravalvular leak, device failure, and short‐term mortality post‐TAVI 39,40 . The impact of LVOT calcification on the development of PPM has not been well studied.…”

“…Severe calcification of the LVOT identified on CT are associated with increased risk of paravalvular leak, device failure, and short-term mortality post-TAVI. 39,40 The impact of LVOT calcification on the development of PPM has not been well studied. This is an important direction for future study.…”

Quantity and location of aortic valve calcification predicts paravalvular leakage after transcatheter aortic valve replacement: a systematic review and meta-analysis

“…It is possible that the perfect anchoring of the prosthesis implantation could have prevented the calcification at the aortic valve annulus. When assessing calcification using MDCT, Kofler et al reported the use of individual-specific Hounsfield unit (HU) thresholds instead of the arbitrarily defined HU thresholds (29). The choice of an empirical, fixed threshold does not consider the variation in the canal attenuation between patients (30).…”