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Does the severity of low-gradient aortic stenosis classified by computed tomography–derived aortic valve calcification determine the outcome of patients after transcatheter aortic valve implantation (TAVI)?

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  • Published:
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Abstract

Objectives

Aortic valve calcification (AVC) determined by computed tomography has emerged as a complementary measure of aortic stenosis (AS) severity and as a predictor of adverse events. Thus, AVC can guide further treatment decisions in patients with low-gradient AS (LG-AS). We compared the symptomatic and prognostic outcome of patients with low vs. high AVC after transcatheter aortic valve implantation (TAVI).

Methods

Patients with an aortic valve area index ≤ 0.6 cm2/m2 and a mean pressure gradient (MPG) < 40 mmHg were classified as low-flow, low-gradient AS (LFLG-AS; stroke volume index [SVI] ≤ 35 ml/m2, left ventricular ejection fraction [LVEF] < 50%, n = 173), paradoxical LFLG-AS (pLFLG-AS, SVI ≤ 35 ml/m2, LVEF ≥ 50%, n = 233), or normal-flow, low-gradient AS (NFLG-AS, SVI > 35 ml/m2, LVEF ≥ 50%, n = 244); patients with MPG ≥ 40 mmHg (n = 1142) served as controls. Patients were further categorized according to published AVC thresholds.

Results

Demographic characteristics and cardiovascular risk were not different between patients with high vs. low AVC in any of the subgroups. Patients with low AVC had a lower MPG. Symptom improvement at 30 days was observed in the majority of patients but was less pronounced in LFLG-AS patients with low vs. those with high AVC. Kaplan-Meier 1-year survival curves were identical between patients with low and high AVC in all three LG-AS groups.

Conclusions

The severity of LG-AS based on AVC has no impact on 1-year prognosis once TAVI has been performed.

Key Points

• Aortic valve calcification (AVC) determined by computed tomography has emerged as a complementary measure of aortic stenosis (AS) severity and is of prognostic value in selected patients.

• Patients with inconsistent echocardiographic measures can be classified as having severe or nonsevere AS by the computed tomography–derived AVC score.

• The prognostic value of AVC in patients with low-gradient AS is abrogated after correction of afterload by TAVI.

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Abbreviations

AS:

Aortic stenosis

AVA:

Aortic valve area

AVC:

Aortic valve calcification

AVCd:

AVC density

LFLG:

Low flow, low gradient

LG:

Low gradient

LV:

Left ventricular

LVEF:

Left ventricular ejection fraction

MPG:

Transvalvular mean pressure gradient

NFLG:

Normal flow, low gradient

NYHA:

New York Heart Association

pLFLG:

Paradoxical low flow, low gradient

SV:

Stroke volume

SVI:

Stroke volume index

TAVI:

Transcatheter aortic valve implantation

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Acknowledgments

We thank Elizabeth Martinson for excellent editorial work.

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231, Bad Nauheim, Germany

    Ulrich Fischer-Rasokat, Matthias Renker, Christoph Liebetrau, Maren Weferling, Andreas Rolf, Christian W. Hamm & Won-Keun Kim

  2. Medical Clinic I (Cardiology and Angiology), University Hospital of Giessen, Klinikstr. 33, 35392, Giessen, Germany

    Ulrich Fischer-Rasokat, Christoph Liebetrau, Andreas Rolf, Christian W. Hamm & Won-Keun Kim

  3. Department of Cardiac Surgery, Kerckhoff Heart Center, Benekestr. 2-8, 61231, Bad Nauheim, Germany

    Matthias Renker, Mirko Doss, Thomas Walther & Won-Keun Kim

  4. German Centre for Cardiovascular Research (DZHK), Partner Site RhineMain, Bad Nauheim, Germany

    Matthias Renker, Christoph Liebetrau, Andreas Rolf, Thomas Walther & Christian W. Hamm

  5. Department of Cardiology, Medical Clinic I, St. Johannes Hospital, Johannesstr. 9-17, 44137, Dortmund, Germany

    Helge Möllmann

  6. Department of Cardiac, Thoracic and Thoracic Vascular Surgery, University Hospital of the Goethe University, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany

    Thomas Walther

Authors
  1. Ulrich Fischer-Rasokat
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Corresponding author

Correspondence to Ulrich Fischer-Rasokat.

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Guarantor

The scientific guarantor of this publication is Ulrich Fischer-Rasokat.

Conflict of interest

The authors of this manuscript declare relationships with the following companies:

Ulrich Fischer-Rasokat: no personal disclosures in relation to the manuscript

Matthias Renker: speaker fees from St. Jude Medical, Abbott

Christoph Liebetrau: speaker fees from Abbott

Maren Weferling: no personal disclosures in relation to the manuscript

Andreas Rolf: no personal disclosures in relation to the manuscript

Mirko Doss: proctor fees for Boston Scientific

Helge Möllmann: proctor/speaker fees from Abbott, Biotronik, Boston Scientific, Edwards Lifesciences, St. Jude Medical

Thomas Walther: no personal disclosures in relation to the manuscript

Christian W. Hamm: advisory board Medtronic

Won-Keun Kim: proctor/speaker fees from Boston Scientific, Abbott, St. Jude Medical, Edwards Lifesciences

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Fischer-Rasokat, U., Renker, M., Liebetrau, C. et al. Does the severity of low-gradient aortic stenosis classified by computed tomography–derived aortic valve calcification determine the outcome of patients after transcatheter aortic valve implantation (TAVI)?. Eur Radiol 31, 549–558 (2021). https://doi.org/10.1007/s00330-020-07121-z

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