The aortic valve calcium nodule score (AVCNS) independently predicts paravalvular regurgitation after transcatheter aortic valve replacement (TAVR)

Lorenzo Azzalini, Brian B. Ghoshhajra, Sammy Elmariah, Jonathan J. Passeri, Ignacio Inglessis, Igor F. Palacios, Suhny Abbara

Research output: Contribution to journalArticle

18 Scopus citations

Abstract

Background: Paravalvular regurgitation (PVR) is an important predictor of mortality after transcatheter aortic valve replacement (TAVR). Aortic valve (AV) calcification is strongly associated with PVR. Objectives: This 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. Methods: In 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. Results: Mean age was 84.1 ± 7.6years (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. Conclusions: AVCNS, 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.

Original languageEnglish (US)
Pages (from-to)131-140
Number of pages10
JournalJournal of cardiovascular computed tomography
Volume8
Issue number2
DOIs
StatePublished - Mar 2014

Keywords

  • Aortic valve
  • Calcification
  • Calcium
  • Computed tomography
  • Paravalvular regurgitation
  • Transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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