Objectives: We sought to determine the impact of aortic root calcium on the risk of significant paravalvular regurgitation (sPAR) in transcatheter aortic valve replacement (TAVR).Methods: In 302 consecutive patients from 3 centers, aortic root calcium was quantified volumetrically on pre-TAVR multidetector computed tomography (MDCT) in three regions: 1) the aortic valve region, 2) the overall left ventricular outflow tract (LVOT) and 3) the upper LVOT. Transcathether heart valve (THV) oversizing was calculated as (THV nominal area/MDCT annular area-1) x 100. The study endpoint sPAR was a composite of post-dilatation (PD) and PAR > mild.Results: sPAR occurred in 15% (46/302) of patients. Upper LVOT calcium volume was more predictive of sPAR than overall LVOT calcium volume, with an area under the receiver operating curve (AUC) (95% confidence interval [CI]) of 0.80 (0.67-0.89) vs. 0.60 (0.51-0.70); p = 0.0001. The optimal cut-off calcium volume thresholds determined from receiver operating curves were 21 mm(3) and 30 mm(3) for upper LVOT and overall LVOT calcium, respectively. Upper LVOT calcium >= 21 mm(3), but not overall LVOT calcium >= 30 mm(3), independently predicted sPAR, odds ratio (95% CI): 9.5 (4.1-22.3) vs 1.6 (0.6-2.7). Upper LVOT calcium was more predictive of sPAR in patients with THV oversizing >= 13% compared to patients with THV oversizing >= 13%, AUC (95% CI): 0.83 (0.72-0.93) vs. 0.67 (0.51-0.74); p < 0.0001.Conclusions: Upper LVOT calcium predicts more-than-mild paravalvular regurgitation following TAVR or the need for postdilatation. Upper LVOT calcium is most predictive of paravalvular regurgitation in the event of THV oversizing >= 13%.

Aortic valve and left ventricular outflow tract calcium volume and distribution in transcatheter aortic valve replacement: Influence on the risk of significant paravalvular regurgitation

Rossi, Alexia;
2018-01-01

Abstract

Objectives: We sought to determine the impact of aortic root calcium on the risk of significant paravalvular regurgitation (sPAR) in transcatheter aortic valve replacement (TAVR).Methods: In 302 consecutive patients from 3 centers, aortic root calcium was quantified volumetrically on pre-TAVR multidetector computed tomography (MDCT) in three regions: 1) the aortic valve region, 2) the overall left ventricular outflow tract (LVOT) and 3) the upper LVOT. Transcathether heart valve (THV) oversizing was calculated as (THV nominal area/MDCT annular area-1) x 100. The study endpoint sPAR was a composite of post-dilatation (PD) and PAR > mild.Results: sPAR occurred in 15% (46/302) of patients. Upper LVOT calcium volume was more predictive of sPAR than overall LVOT calcium volume, with an area under the receiver operating curve (AUC) (95% confidence interval [CI]) of 0.80 (0.67-0.89) vs. 0.60 (0.51-0.70); p = 0.0001. The optimal cut-off calcium volume thresholds determined from receiver operating curves were 21 mm(3) and 30 mm(3) for upper LVOT and overall LVOT calcium, respectively. Upper LVOT calcium >= 21 mm(3), but not overall LVOT calcium >= 30 mm(3), independently predicted sPAR, odds ratio (95% CI): 9.5 (4.1-22.3) vs 1.6 (0.6-2.7). Upper LVOT calcium was more predictive of sPAR in patients with THV oversizing >= 13% compared to patients with THV oversizing >= 13%, AUC (95% CI): 0.83 (0.72-0.93) vs. 0.67 (0.51-0.74); p < 0.0001.Conclusions: Upper LVOT calcium predicts more-than-mild paravalvular regurgitation following TAVR or the need for postdilatation. Upper LVOT calcium is most predictive of paravalvular regurgitation in the event of THV oversizing >= 13%.
2018
Aortic valve insufficiency
Echocardiography
Heart valve prosthesis
Multidetector computed tomography
Transcatheter aortic valve replacement
Aged
Aged, 80 and over
Aortic Valve
Aortic Valve Insufficiency
Aortic Valve Stenosis
Area Under Curve
British Columbia
Calcinosis
Calcium
Chi-Square Distribution
Denmark
Echocardiography, Transesophageal
Female
Heart Valve Prosthesis
Heart Ventricles
Humans
Logistic Models
London
Male
Multidetector Computed Tomography
Multivariate Analysis
Odds Ratio
Predictive Value of Tests
Proportional Hazards Models
Prosthesis Design
ROC Curve
Reproducibility of Results
Risk Factors
Severity of Illness Index
Time Factors
Transcatheter Aortic Valve Replacement
Treatment Outcome
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11699/59385
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