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

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• 作者：Ralf Koos (1)
  Sebastian Reinartz (2)
  Andreas Horst Mahnken (3)
  Ralf Herpertz (1)
  Shahram Lotfi (4)
  Riger Autschbach (4)
  Nikolaus Marx (1)
  Rainer Hoffmann (1)
  
• 关键词：Cardiac computed tomography ; Aortic valve stenosis ; Calcification ; Heart valve diseases ; Prognosis
• 刊名：European Radiology
• 出版年：2013
• 出版时间：December 2013
• 年：2013
• 卷：23
• 期：12
• 页码：3253-3261
• 全文大小：
• 作者单位：Ralf Koos (1)
  Sebastian Reinartz (2)
  Andreas Horst Mahnken (3)
  Ralf Herpertz (1)
  Shahram Lotfi (4)
  Riger Autschbach (4)
  Nikolaus Marx (1)
  Rainer Hoffmann (1)
  
  1. Department of Cardiology, University Hospital RWTH Aachen, RWTH University Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
  2. Department of Diagnostic Radiology, University Hospital RWTH Aachen, RWTH University Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
  3. Department of Diagnostic Radiology, University Hospital Marburg, Marburg, Germany
  4. Department of Cardiac and Thoracic Surgery, University Hospital RWTH Aachen, RWTH University Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
  
• ISSN：1432-1084

文摘

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 30days was 91%, and it was 75%, 66% and 64% at 1, 2years and 3years, respectively. Non-survivors at 3years showed a significantly higher Agatston AVC score (2,8541,651) than survivors (1,854961, 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.