Prognostic value of aortic root calcification volume on clinical outcomes after transcatheter balloon-expandable aortic valve implantation

Yusuke Watanabe, Thierry Lefèvre, Erik Bouvier, Takahide Arai, Kentaro Hayashida, Bernard Chevalier, Mauro Romano, Thomas Hovasse, Philippe Garot, Patrick Donzeau-Gouge, Arnaud Farge, Bertrand Cormier, Marie Claude Morice

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background Few data are available about whether aortic root calcification may impact the outcomes after transcatheter aortic valve implantation (TAVI). Objectives This study sought to evaluate the impact of aortic root calcification volume on clinical outcome after TAVI with balloon expandable Edwards Sapien XT valve (Edwards Lifesciences, Irvine, California). Methods A total of 162 TAVI patients (aged 84.0 [Interquartile Range (IQR) 81.0-84.0] years, Logistic EuroSCORE 14.5 [IQR 9.8-25.1]) with preprocedural MDCT were studied. Aortic root calcification volume was measured by MDCT image and using the dedicated software for aortic valve assessment (the automated 3mensioTM Valves 5.1, sp1, 3mensio Pie Medical Imaging BV, Maastricht, the Netherlands). A valve calcification index (VCI) was defined as calcification volume (mm3)/body surface area (mm2). Results VCI was significantly higher among patients with 30-day mortality. A VCI threshold of 517.4 (area under the curve 0.69, 95% CI 0.50-0.87, P = 0.03) predicted a higher incidence of annulus rupture (9.1 vs. 0.9%, P = 0.02) and cardiac tamponade (12.7 vs. 1.9%, P <0.01), lower device success (83.6% vs. 95.3%, P <0.01) and 30-day survival rate (80.0% vs. 97.2%, P <0.01). Multivariate logistic regression analysis showed only ejection fraction and VCI were identified as independent predictors of 30-day mortality (Odds ratio 0.948 [95% confidence interval 0.909-0.988], P = 0.012, Odds ratio 1.003 [95% confidence interval 1.001-1.005], P = 0.013, respectively). Conclusions Significantly worse acute clinical outcomes after Edwards valve implantation were observed in patients with large amount of aortic annulus calcifications quantitatively measured by dedicated MDCT software. Application of VCI may prove helpful in prediction of clinical outcomes after TAVI.

Original languageEnglish
Pages (from-to)1105-1113
Number of pages9
JournalCatheterization and Cardiovascular Interventions
Volume86
Issue number6
DOIs
Publication statusPublished - 2015 Nov 15

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Aortic Valve
Software
Odds Ratio
Confidence Intervals
Cardiac Tamponade
Mortality
Body Surface Area
Diagnostic Imaging
Netherlands
Area Under Curve
Rupture
Survival Rate
Logistic Models
Regression Analysis
Equipment and Supplies
Transcatheter Aortic Valve Replacement
Incidence

Keywords

  • annulus rupture
  • balloon-expandable valve
  • calcification
  • multislice computed tomography
  • transcatheter aortic valve implantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Prognostic value of aortic root calcification volume on clinical outcomes after transcatheter balloon-expandable aortic valve implantation. / Watanabe, Yusuke; Lefèvre, Thierry; Bouvier, Erik; Arai, Takahide; Hayashida, Kentaro; Chevalier, Bernard; Romano, Mauro; Hovasse, Thomas; Garot, Philippe; Donzeau-Gouge, Patrick; Farge, Arnaud; Cormier, Bertrand; Morice, Marie Claude.

In: Catheterization and Cardiovascular Interventions, Vol. 86, No. 6, 15.11.2015, p. 1105-1113.

Research output: Contribution to journalArticle

Watanabe, Y, Lefèvre, T, Bouvier, E, Arai, T, Hayashida, K, Chevalier, B, Romano, M, Hovasse, T, Garot, P, Donzeau-Gouge, P, Farge, A, Cormier, B & Morice, MC 2015, 'Prognostic value of aortic root calcification volume on clinical outcomes after transcatheter balloon-expandable aortic valve implantation', Catheterization and Cardiovascular Interventions, vol. 86, no. 6, pp. 1105-1113. https://doi.org/10.1002/ccd.25986
Watanabe, Yusuke ; Lefèvre, Thierry ; Bouvier, Erik ; Arai, Takahide ; Hayashida, Kentaro ; Chevalier, Bernard ; Romano, Mauro ; Hovasse, Thomas ; Garot, Philippe ; Donzeau-Gouge, Patrick ; Farge, Arnaud ; Cormier, Bertrand ; Morice, Marie Claude. / Prognostic value of aortic root calcification volume on clinical outcomes after transcatheter balloon-expandable aortic valve implantation. In: Catheterization and Cardiovascular Interventions. 2015 ; Vol. 86, No. 6. pp. 1105-1113.
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T1 - Prognostic value of aortic root calcification volume on clinical outcomes after transcatheter balloon-expandable aortic valve implantation

AU - Watanabe, Yusuke

AU - Lefèvre, Thierry

AU - Bouvier, Erik

AU - Arai, Takahide

AU - Hayashida, Kentaro

AU - Chevalier, Bernard

AU - Romano, Mauro

AU - Hovasse, Thomas

AU - Garot, Philippe

AU - Donzeau-Gouge, Patrick

AU - Farge, Arnaud

AU - Cormier, Bertrand

AU - Morice, Marie Claude

PY - 2015/11/15

Y1 - 2015/11/15

N2 - Background Few data are available about whether aortic root calcification may impact the outcomes after transcatheter aortic valve implantation (TAVI). Objectives This study sought to evaluate the impact of aortic root calcification volume on clinical outcome after TAVI with balloon expandable Edwards Sapien XT valve (Edwards Lifesciences, Irvine, California). Methods A total of 162 TAVI patients (aged 84.0 [Interquartile Range (IQR) 81.0-84.0] years, Logistic EuroSCORE 14.5 [IQR 9.8-25.1]) with preprocedural MDCT were studied. Aortic root calcification volume was measured by MDCT image and using the dedicated software for aortic valve assessment (the automated 3mensioTM Valves 5.1, sp1, 3mensio Pie Medical Imaging BV, Maastricht, the Netherlands). A valve calcification index (VCI) was defined as calcification volume (mm3)/body surface area (mm2). Results VCI was significantly higher among patients with 30-day mortality. A VCI threshold of 517.4 (area under the curve 0.69, 95% CI 0.50-0.87, P = 0.03) predicted a higher incidence of annulus rupture (9.1 vs. 0.9%, P = 0.02) and cardiac tamponade (12.7 vs. 1.9%, P <0.01), lower device success (83.6% vs. 95.3%, P <0.01) and 30-day survival rate (80.0% vs. 97.2%, P <0.01). Multivariate logistic regression analysis showed only ejection fraction and VCI were identified as independent predictors of 30-day mortality (Odds ratio 0.948 [95% confidence interval 0.909-0.988], P = 0.012, Odds ratio 1.003 [95% confidence interval 1.001-1.005], P = 0.013, respectively). Conclusions Significantly worse acute clinical outcomes after Edwards valve implantation were observed in patients with large amount of aortic annulus calcifications quantitatively measured by dedicated MDCT software. Application of VCI may prove helpful in prediction of clinical outcomes after TAVI.

AB - Background Few data are available about whether aortic root calcification may impact the outcomes after transcatheter aortic valve implantation (TAVI). Objectives This study sought to evaluate the impact of aortic root calcification volume on clinical outcome after TAVI with balloon expandable Edwards Sapien XT valve (Edwards Lifesciences, Irvine, California). Methods A total of 162 TAVI patients (aged 84.0 [Interquartile Range (IQR) 81.0-84.0] years, Logistic EuroSCORE 14.5 [IQR 9.8-25.1]) with preprocedural MDCT were studied. Aortic root calcification volume was measured by MDCT image and using the dedicated software for aortic valve assessment (the automated 3mensioTM Valves 5.1, sp1, 3mensio Pie Medical Imaging BV, Maastricht, the Netherlands). A valve calcification index (VCI) was defined as calcification volume (mm3)/body surface area (mm2). Results VCI was significantly higher among patients with 30-day mortality. A VCI threshold of 517.4 (area under the curve 0.69, 95% CI 0.50-0.87, P = 0.03) predicted a higher incidence of annulus rupture (9.1 vs. 0.9%, P = 0.02) and cardiac tamponade (12.7 vs. 1.9%, P <0.01), lower device success (83.6% vs. 95.3%, P <0.01) and 30-day survival rate (80.0% vs. 97.2%, P <0.01). Multivariate logistic regression analysis showed only ejection fraction and VCI were identified as independent predictors of 30-day mortality (Odds ratio 0.948 [95% confidence interval 0.909-0.988], P = 0.012, Odds ratio 1.003 [95% confidence interval 1.001-1.005], P = 0.013, respectively). Conclusions Significantly worse acute clinical outcomes after Edwards valve implantation were observed in patients with large amount of aortic annulus calcifications quantitatively measured by dedicated MDCT software. Application of VCI may prove helpful in prediction of clinical outcomes after TAVI.

KW - annulus rupture

KW - balloon-expandable valve

KW - calcification

KW - multislice computed tomography

KW - transcatheter aortic valve implantation

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