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

Koos, Ralf; Reinartz, Sebastian; Mahnken, Andreas Horst; Herpertz, Ralf; Lotfi, Shahram; Autschbach, Rüdiger; Marx, Nikolaus; Hoffmann, Rainer
December 2013
European Radiology;Dec2013, Vol. 23 Issue 12, p3253
Academic Journal
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.


Related Articles

  • Midregional Proadrenomedullin Improves Risk Stratification beyond Surgical Risk Scores in Patients Undergoing Transcatheter Aortic Valve Replacement. Csordas, Adam; Nietlispach, Fabian; Schuetz, Philipp; Huber, Andreas; Müller, Beat; Maisano, Francesco; Taramasso, Maurizio; Moarof, Igal; Obeid, Slayman; Stähli, Barbara E.; Cahenzly, Martin; Binder, Ronald K.; Liebetrau, Christoph; Möllmann, Helge; Kim, Won-Keun; Hamm, Christian; Lüscher, Thomas F. // PLoS ONE;12/2/2015, Vol. 10 Issue 12, p1 

    Background: Conventional surgical risk scores lack accuracy in risk stratification of patients undergoing transcatheter aortic valve replacement (TAVR). Elevated levels of midregional proadrenomedullin (MR-proADM) levels are associated with adverse outcome not only in patients with manifest...

  • Automatic segmentation of the aortic root in CT angiography of candidate patients for transcatheter aortic valve implantation. Elattar, M.; Wiegerinck, E.; Planken, R.; vanbavel, E.; Assen, H.; Baan, J.; Marquering, H. // Medical & Biological Engineering & Computing;Jul2014, Vol. 52 Issue 7, p611 

    Transcatheter aortic valve implantation is a minimal-invasive intervention for implanting prosthetic valves in patients with aortic stenosis. Accurate automated sizing for planning and patient selection is expected to reduce adverse effects such as paravalvular leakage and stroke. Segmentation...

  • Adiponectin: an accurate biomarker for patients at risk for atrial fibrillation? Ruparelia, Neil; Prendergast, Bernard D. // Heart;Sep2015, Vol. 101 Issue 17, p1351 

    The article focuses on a study on treatment of aortic stenosis (AS) by transcatheter aortic valve implantation (TAVI). Topics discussed include testing efficacy of TAVI by placement of aortic transcatheter valves (PARTNER) I trial, techniques used for evaluating aortic valve function such as...

  • Heartbeat: Highlights from this issue. Otto, Catherine M. // Heart;Oct2014, Vol. 100 Issue 20, p1563 

    An introduction is presented in which the editor discusses various research articles within the issue on topics including aortic valve replacement in patients with severe symptomatic aortic stenosis (AS), clinical factors in coronary disease events and clinical guidelines in daily practice.

  • Options Expand for Treating Common Heart-Valve Disorder.  // Cleveland Clinic Men's Health Advisor;Feb2013, Vol. 15 Issue 2, p1 

    The article focuses on transcatheter aortic valve replacement for treating aortic valve stenosis in patients. It states that around 1.5 million Americans are suffering from aortic stenosis and will survive not more than two years after symptoms develop. As the disease intensify, patient may...

  • Transcatheter Aortic Valve Replacement: A Physician-Patient's Story. Fred, Herbert L. // Texas Heart Institute Journal;Aug2015, Vol. 42 Issue 4, p305 

    A personal narrative is presented which explores the author's experiences as a physician undergoing transcatheter aortic valve replacement to treat his aortic stenosis.

  • Short-term and medium-term outcomes of transapical aortic valve implantation as a single-strategy approach: one center's experience. Čanádyová, Júlia; Mokráček, Aleš; Pešl, Ladislav; Kurfirst, Vojtĕch; Šulda, Mirek // Polish Journal of Thoracic & Cardiovascular Surgery;2015, Vol. 12 Issue 2, p95 

    Introduction: Transcatheter aortic valve replacement has been developed as an alternative option for surgical high-risk or inoperable patients with severe symptomatic aortic stenosis. Aim of the study was to evaluate the outcomes of patients undergoing transapical aortic valve replacement as a...

  • Aortic valve replacement surgery reveals previously undiagnosed alkaptonuric ochronosis. Pfeffer, Christian; Bagaev, Erik; Sotlar, Karl; Hagl, Christian // European Journal of Cardio-Thoracic Surgery;Jan2015, Vol. 47 Issue 1, p194 

    The article presents a case study of a 64-year-old patient with aortic stenosis undergone surgical aortic valve replacement and diagnosis revealed dark ochronotic pigment in the valvular tissue.

  • Percutaneous Transcatheter Aortic Valve Implantation: A Review Focus on Outcomes and Safety. Ortega-Paz, Luis; Giacchi, Giuseppe; Brugaletta, Salvatore; Sabaté, Manel // AIMS Medical Science;Jul2015, Vol. 2 Issue 3, p200 

    Aortic stenosis is highly prevalent in the elderly, when symptomatic, is associated with high mortality. Although its treatment is mainly surgical, cumulative evidence has demonstrated that transcatheter aortic valve implantation is an effective and safe treatment option for selected patients,...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics