Predictors of calcification distribution in severe tricuspid aortic valve stenosis

• Published in: The International Journal of Cardiovascular Imaging Vol. 37; no. 9; pp. 2791 - 2799
• Main Authors: Piayda, Kerstin, Dannenberg, Lisa, Zako, Saif, Maier, Oliver, Bosbach, Georg, Polzin, Amin, Afzal, Shazia, Jung, Christian, Westenfeld, Ralf, Kelm, Malte, Zeus, Tobias, Veulemans, Verena
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.09.2021; Springer Nature B.V
• Subjects: Aorta; Aortic valve; Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - surgery; Asymmetry; Calcification; Calcification (ectopic); Cardiac Imaging; Cardiology; Computed tomography; Cusps; Female; Females; Heart; Heart valves; Humans; Imaging; Medical imaging; Medicine; Medicine & Public Health; Multidetector Computed Tomography; Multivariate analysis; Original Paper; Patients; Predictive Value of Tests; Radiology; Regression analysis; Retrospective Studies; Severity of Illness Index; Stenosis; Transcatheter Aortic Valve Replacement - adverse effects; Ventricle; Workstations; Leaflet calcification; Multi‐sliced computed tomography analysis; Aortic valve calcification distribution; Severe aortic stenosis; TAVR
• ISSN: 1569-5794; 1573-0743; 1875-8312
• DOI: 10.1007/s10554-021-02248-6

We investigated aortic valve calcification (AVC) distribution and predictors for leaflet calcification patterns in patients with severe tricuspid aortic valve stenosis undergoing transcatheter aortic valve replacement (TAVR). Patients undergoing routine multi-sliced computed tomography (MSCT) for procedural planning were enrolled. MSCT data were transferred to a dedicated workstation for evaluation (3mensio Structural Heart™, Pie Medical Imaging BV, Maastricht, The Netherlands) and analyzed. Participants were separated into asymmetrical (AC) and symmetrical (SC) leaflet calcification and potential predictors for calcification distribution were identified with univariate and multivariate regression analysis. 567 Participants with severe tricuspid AS were divided into asymmetrical (AC, n = 443; 78.1%) and symmetrical (SC, n = 124; 21.9%) AVC. In AC, the non-coronary cusp was the most calcified cusp (n = 238; 57.7%). SC is more common in females (AC/SC: 49.2% vs. 67.7%; p < 0.0001). AVC was more severe in patients with AC, who also have larger aortic root dimensions. Multivariate analysis depicted, inter alia, left ventricular outflow tract (LVOT) calcification < 25 Agatston units (OR 1.81 [1.09–3.00], p = 0.021), a mean pressure gradient < 36 mmHg (OR 1.77 [1.03–3.05], p = 0.039), and an annulo-apical angle > 67° (OR 1.68 [1.00–2.80], p = 0.049) as predictors for SC, although with only moderate predictive value. Data from this retrospective analysis indicate that SC occurs more frequently in females. The cumulative leaflet calcification burden is higher in patients with AC, who also present with larger aortic root dimensions. The predictive value for prominent calcification of different aortic valve cusps in AC patients was only low to moderate. Trial registration number : NCT01805739.