Prognostic Impact of Calcium Score after Transcatheter Aortic Valve Implantation Performed With New Generation Prosthesis

Akodad, Mariama; Lattuca, Benoît; Agullo, Audrey; Macia, Jean‐Christophe; Gandet, Thomas; Marin, Grégory; Iemmi, Anaïs; Vernhet, Hélène; Schmutz, Laurent; Nagot, Nicolas; Albat, Bernard; Cayla, Guillaume; Leclercq, Florence

doi:10.1016/j.amjcard.2018.02.004

Cited by 19 publications

(8 citation statements)

References 26 publications

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“…33 Although aortic valve calcium was found to be associated with severe procedural complications, transcatheter aortic valves of second generations have been shown to remain less impacted by the extent of landing zone calcium. 34,35 We extend these observations by demonstrating that both total aortic tissue volume and the volume of non-calcific aortic valve tissue, but not calcific tissue alone, can predict 30-day MACEs (composite of cardiovascular death, all-stroke, and myocardial infarction) post-TAVI. Interestingly, histopathological analysis of debris captured with cerebral protection device during TAVI showed different forms of non-calcific tissue and thrombus to compose the majority of the liberated material.…”

Section: Discussionmentioning

confidence: 58%

Non-calcific aortic tissue quantified from computed tomography angiography improves diagnosis and prognostication of patients referred for transcatheter aortic valve implantation

Grodecki

Tamarappoo

Huczek

et al. 2020

European Heart Journal - Cardiovascular Imaging

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Aims We aimed to investigate the role of aortic valve tissue composition from quantitative cardiac computed tomography angiography (CTA) in patients with severe aortic stenosis (AS) for the differentiation of disease subtypes and prognostication after transcatheter aortic valve implantation (TAVI). Methods and results Our study included 447 consecutive AS patients from six high-volume centres reporting to a prospective nationwide registry of TAVI procedures (POL-TAVI), who underwent cardiac CTA before TAVI, and 224 matched controls with normal aortic valves. Components of aortic valve tissue were identified using semi-automated software as calcific and non-calcific. Volumes of each tissue component and composition [(tissue component volume/total tissue volume) × 100%] were quantified. Relationship of aortic valve composition with clinical outcomes post-TAVI was evaluated using Valve Academic Research Consortium (VARC)-2 definitions. High-gradient (HG) AS patients had significantly higher aortic tissue volume compared to low-flow low-gradient (LFLG)-AS (1672.7 vs. 1395.3 mm3, P < 0.001) as well as controls (509.9 mm3, P < 0.001), but increased non-calcific tissue was observed in LFLG compared to HG patients (1063.6 vs. 860.2 mm3, P < 0.001). Predictive value of aortic valve calcium score [area under the curve (AUC) 0.989, 95% confidence interval (CI): 0.981–0.996] for severe AS was improved after addition of non-calcific tissue volume (AUC 0.995, 95% CI: 0.991–0.999, P = 0.011). In the multivariable analysis of clinical and quantitative computed tomography parameters of aortic valve tissue, non-calcific tissue volume [odds ratio (OR) 5.2, 95% CI 1.8–15.4, P = 0.003] and history of stroke (OR 2.6, 95% CI 1.1–6.5, P = 0.037) were independent predictors of 30-day major adverse cardiovascular event (MACE). Conclusion Quantitative CTA assessment of aortic valve tissue volume and composition can improve detection of severe AS, differentiation between HG and LFLG-AS in patients referred for TAVI as well as prediction of 30-day MACEs post-TAVI, over the current clinical standard.

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Section: Discussionmentioning

confidence: 58%

Non-calcific aortic tissue quantified from computed tomography angiography improves diagnosis and prognostication of patients referred for transcatheter aortic valve implantation

Grodecki

Tamarappoo

Huczek

et al. 2020

European Heart Journal - Cardiovascular Imaging

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“…Ren et al proved that AVCS evaluation is a reliable marker in the evaluation of AS severity, also in patients with bicuspid aortic valve stenosis [ 21 ]. Scientific literature also discusses the significance of the AVCS onset value as a prognostic factor in patients who underwent the TAVI procedure [ 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Estimation of Aortic Valve Calcium Score Based on Angiographic Phase Versus Reduction of Ionizing Radiation Dose in Computed Tomography

Gać

Kȩdzierski²,

Macek

et al. 2021

Life

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The aim of the study was to evaluate the estimation efficacy of aortic valve calcium score (AVCS) based on the multislice computed tomography (MSCT) angiographic phase. The evaluation of the reduced amount of ionizing radiation dose was performed because of this estimation. The study included 51 consecutive patients who qualified for transcatheter aortic valve implantation (TAVI) (78.59 ± 5.72 years). All subjects underwent MSCT: in the native phase dedicated to AVCS as well as angiographic phases aimed to morphologically assess the aortic ostium and arterial accesses for TAVI. Based on the native phase, an AVCS assessment was performed for axial reconstructions at 3.0 mm and 2.0 mm slice thickness (AVCSnative3.0 and AVCSnative2.0). Based on the angiographic phase AVCS was estimated for axial reconstruction at 0.6 mm slice thickness with increased values of lesion density in aortic valve cusps/aortic valve annulus, which is considered a calcification, from a typical value of 130 HU to 500 HU and 600 HU (AVCSCTA0.6 500 HU and AVCSCTA0.6 600 HU). Mathematical formulations were developed, allowing for AVCS native calculation based on AVCS values estimated based on the angiographic phase: AVCSnative3.0 = 813.920 + 1.510 AVCSCTA0.6 500 HU; AVCSnative3.0 = 1235.863 + 1.817 AVCSCTA0.6 600 HU; AVCSnative2.0 = 797.471 + 1.393 AVCSCTA0.6 500 HU; AVCSnative2.0 = 1228.310 + 1.650 AVCSCTA0.6 600 HU. The amount of a potential reduction in dose length product (DLP) in the case of AVCS estimation was 4.45 ± 1.54%. In summary, relying solely on the angiographic phase of MSCT examination before TAVI, it is possible to conclusively estimate AVCS. This estimation results in a marked reduction in radiation dose in MSCT.

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“…13 The mechanisms underlying the association of VAC with post-TAVI outcomes may be linked to an increased rate of periprocedural complications, device failure, pacemaker implantation, or paravalvular leak. 14,15 AS severity, and thus VAC, is also correlated with myocardial fibrosis, 16 which is mostly irreversible and influences post-operative mortality 17 and heart failure. 18 This may explain that VAC continued to have a prognostic significance over the long run, i.e.…”

Section: Discussionmentioning

confidence: 99%

Prognostic significance of vascular and valvular calcifications in low- and high-gradient aortic stenosis

Harbaoui

Ghigo

Boussel

et al. 2021

European Heart Journal - Cardiovascular Imaging

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Aims In low-gradient aortic stenosis (LGAS), the high valvulo-arterial impedance observed despite low valvular gradient suggests a high vascular load. Thoracic aortic calcifications (TACs) and valvular aortic calcifications (VACs) are, respectively, surrogates of aortic load and aortic valvular gradient. The aim of this study was to compare the respective contributions of TAC and VAC on 3-year cardiovascular (CV) mortality following TAVI in LGAS vs. high-gradient aortic stenosis (HGAS) patients. Methods and results A total of 1396 consecutive patients were included. TAC and VAC were measured on the pre-TAVI CT-scan. About 435 (31.2%) patients had LGAS and 961 (68.8%) HGAS. LGAS patients were more prone to have diabetes, coronary artery disease (CAD), atrial fibrillation (AF), and lower left ventricular ejection fraction (LVEF), P<0.05 for all. During the 3 years after TAVI, 245(17.8%) patients experienced CV mortality, 92(21.6%) in LGAS and 153(16.2%) in HGAS patients, P=0.018. Multivariate analysis adjusted for age, gender, diabetes, AF, CAD, LVEF, renal function, vascular access, and aortic regurgitation showed that TAC but not VAC was associated with CV mortality in LGAS, hazard ratio (HR) 1.085 confidence interval (CI) (1.019–1.156), P=0.011, and HR 0.713 CI (0.439–1.8), P=0.235; the opposite was observed in HGAS patients with VAC but not TAC being associated with CV mortality, HR 1.342 CI (1.034–1.742), P=0.027, and HR 1.015 CI (0.955–1.079), P=0.626. Conclusion TAC plays a major prognostic role in LGAS while VAC remains the key in HGAS patients. This confirms that LGAS is a complex vascular and valvular disease.

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Prognostic Impact of Calcium Score after Transcatheter Aortic Valve Implantation Performed With New Generation Prosthesis

Cited by 19 publications

References 26 publications

Non-calcific aortic tissue quantified from computed tomography angiography improves diagnosis and prognostication of patients referred for transcatheter aortic valve implantation

Non-calcific aortic tissue quantified from computed tomography angiography improves diagnosis and prognostication of patients referred for transcatheter aortic valve implantation

Estimation of Aortic Valve Calcium Score Based on Angiographic Phase Versus Reduction of Ionizing Radiation Dose in Computed Tomography

Prognostic significance of vascular and valvular calcifications in low- and high-gradient aortic stenosis

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