Quantity and Location of Aortic Valve Complex Calcification Predicts Severity and Location of Paravalvular Regurgitation and Frequency of Post-Dilation After Balloon-Expandable Transcatheter Aortic Valve Replacement

• Published in: JACC. Cardiovascular interventions Vol. 7; no. 8; pp. 885 - 894
• Main Authors: Khalique, Omar K., MD, Hahn, Rebecca T., MD, Gada, Hemal, MD, Nazif, Tamim M., MD, Vahl, Torsten P., MD, George, Isaac, MD, Kalesan, Bindu, PhD, MPH, Forster, Molly, BA, Williams, Mathew B., MD, Leon, Martin B., MD, Einstein, Andrew J., MD, PhD, Pulerwitz, Todd C., MD, Pearson, Gregory D.N., MD, PhD, Kodali, Susheel K., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2014
• Subjects: Aged; Aged, 80 and over; aortic regurgitation; Aortic Valve - diagnostic imaging; Aortic Valve - pathology; Aortic Valve - physiopathology; Aortic Valve Insufficiency - diagnosis; Aortic Valve Insufficiency - etiology; Aortic Valve Insufficiency - physiopathology; Aortic Valve Stenosis - complications; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - therapy; aortic stenosis; Area Under Curve; Balloon Valvuloplasty - adverse effects; calcification; Calcinosis - complications; Calcinosis - diagnosis; Calcinosis - physiopathology; Calcinosis - therapy; Cardiac Catheterization - adverse effects; Cardiac Catheterization - methods; Cardiovascular; Echocardiography, Doppler, Color; Echocardiography, Three-Dimensional; Echocardiography, Transesophageal; Female; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - methods; Humans; Logistic Models; Male; Multidetector Computed Tomography; Multivariate Analysis; Predictive Value of Tests; Risk Factors; ROC Curve; Severity of Illness Index; transcatheter aortic valve replacement; Treatment Outcome; aortic valve calcification; paravalvular regurgitation; LVOT; HU; PVR; TAVR; AUC; receiver-operating characteristic; AnnulusLVOT; multidetector computed tomography; aortic stenosis; computed tomography; THV; ROC; left ventricular outflow tract; transcatheter heart valve; area under the curve; MDCT; AVC; CT; aortic regurgitation; PD; multidetector row computed tomography; TEE; transcatheter aortic valve replacement; annulus and left ventricular outflow tract; Hounsfield units; post-dilation; transesophageal echocardiography; calcification; Ca
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2014.03.007

Abstract Objectives This study sought to determine the impact of quantity and location of aortic valve calcification (AVC) on paravalvular regurgitation (PVR) and rates of post-dilation (PD) immediately after transcatheter aortic valve replacement (TAVR). Background The impact of AVC in different locations within the aortic valve complex is incompletely understood. Methods This study analyzed 150 patients with severe, symptomatic aortic stenosis who underwent TAVR. Total AVC volume scores were calculated from contrast-enhanced multidetector row computed tomography imaging. AVC was divided by leaflet sector and region (Leaflet, Annulus, left ventricular outflow tract [LVOT]), and a combination of LVOT and Annulus (AnnulusLVOT). Asymmetry was assessed. Receiver-operating characteristic analysis was performed with greater than or equal to mild PVR and PD as classification variables. Logistic regression was performed. Results Quantity of and asymmetry of AVC for all regions of the aortic valve complex predicted greater than or equal to mild PVR by receiver-operating characteristic analysis (area under the curve = 0.635 to 0.689), except Leaflet asymmetry. Receiver-operating characteristic analysis for PD was significant for quantity and asymmetry of AVC in all regions, with higher area under the curve values than for PVR (area under the curve = 0.648 to 0.741). On multivariable analysis, Leaflet and AnnulusLVOT calcification were independent predictors of both PVR and PD regardless of multidetector row computed tomography area cover index. Conclusions Quantity and asymmetry of AVC in all regions of the aortic valve complex predict greater than or equal to mild PVR and performance of PD, with the exception of Leaflet asymmetry. Quantity of AnnulusLVOT and Leaflet calcification independently predict PVR and PD when taking into account multidetector row computed tomography area cover index.