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Impact of aortic valve calcification severity and impaired left ventricular function on 3-year results of patients undergoing transcatheter aortic valve replacement

  • Computed Tomography
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Abstract

Objectives

To evaluate clinical pre-interventional predictors of 3-year outcome and mortality in high-risk patients with severe aortic valve stenosis treated with transcatheter aortic valve implantation (TAVI).

Methods

Among 367 patients included in the Aachen TAVI registry, 76 patients with baseline dual-source computed tomography (DSCT) for the quantification of aortic valve calcification (AVC) and a 3-year follow-up were identified.

Results

Survival at 30 days was 91 %, and it was 75 %, 66 % and 64 % at 1, 2 years and 3 years, respectively. Non-survivors at 3 years showed a significantly higher Agatston AVC score (2,854 ± 1,651) than survivors (1,854 ± 961, P = 0.007). Multivariate analysis including age, logistic EuroScore, glomerular filtration rate, Agatston AVC score, ejection fraction < 40 %, NYHA class, baseline medication, chronic lung disease and aortic regurgitation revealed that only the Agatston AVC score (P = 0.03) and impaired left ventricular function (P = 0.001) was significantly associated with mortality. Patients with Agatston AVC scores >2,000 had a significantly lower 3-year survival rate compared with patients with scores <2,000 (47 % vs 79 %, P = 0.004).

Conclusions

In patients referred for TAVI, aortic valve calcification severity and impaired left ventricular function may serve as a predictor of long-term mortality. Therefore, AVC scores easily determined from pre-procedural CT datasets may be used for patient risk stratification.

Key Points

• Dual-source CT provides excellent valve delineation before transcatheter aortic valve implantation (TAVI).

• Aortic valve calcification assessed by cardiac CT predicts mortality in TAVI patients.

• Aortic valve calcification scores can help stratify high-risk patients for TAVI.

• Three-year results show good long-term outcome without evidence of structural valve deterioration.

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Abbreviations

AR:

Aortic regurgitation

AVC:

Aortic valve calcification

DSCT:

Dual-source computed tomography

ECG:

Electrocardiogram

EuroScore:

European System for Cardiac Operative Risk Evaluation

LV:

Left ventricular

NYHA:

New York Heart Association functional class

TAVI:

Transcatheter aortic valve implantation

TEE:

Transoesophageal echocardiography

TTE:

Transthoracic echocardiography

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Correspondence to Ralf Koos.

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Koos, R., Reinartz, S., Mahnken, A.H. et al. Impact of aortic valve calcification severity and impaired left ventricular function on 3-year results of patients undergoing transcatheter aortic valve replacement. Eur Radiol 23, 3253–3261 (2013). https://doi.org/10.1007/s00330-013-2961-4

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  • DOI: https://doi.org/10.1007/s00330-013-2961-4

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