TY - JOUR
T1 - The aortic valve calcium nodule score (AVCNS) independently predicts paravalvular regurgitation after transcatheter aortic valve replacement (TAVR)
AU - Azzalini, Lorenzo
AU - Ghoshhajra, Brian B.
AU - Elmariah, Sammy
AU - Passeri, Jonathan J.
AU - Inglessis, Ignacio
AU - Palacios, Igor F.
AU - Abbara, Suhny
PY - 2014/3
Y1 - 2014/3
N2 - 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.
AB - 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.
KW - Aortic valve
KW - Calcification
KW - Calcium
KW - Computed tomography
KW - Paravalvular regurgitation
KW - Transcatheter aortic valve replacement
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U2 - 10.1016/j.jcct.2013.12.013
DO - 10.1016/j.jcct.2013.12.013
M3 - Article
C2 - 24661826
AN - SCOPUS:84896532390
SN - 1934-5925
VL - 8
SP - 131
EP - 140
JO - Journal of cardiovascular computed tomography
JF - Journal of cardiovascular computed tomography
IS - 2
ER -