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Prognostic significance of vascular and valvular calcifications in low- and high-gradient aortic stenosis

Brahim Harbaoui1,2, Nina Ghigo1, Loic Boussel1,3

  • 1University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15, 7 avenue Jean Capelle 69621 Villeurbanne Cedex, Lyon, France.

European Heart Journal. Cardiovascular Imaging
|March 11, 2021
PubMed

Insights

Thoracic aortic calcifications (TACs) significantly predict cardiovascular death in low-gradient aortic stenosis (LGAS) after TAVI, while valvular aortic calcifications (VACs) are key in high-gradient AS (HGAS). This highlights LGAS as a complex vascular and valvular condition.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Radiology

Background:

  • Low-gradient aortic stenosis (LGAS) presents high valvulo-arterial impedance despite low gradients, suggesting significant vascular load.
  • Thoracic aortic calcifications (TACs) and valvular aortic calcifications (VACs) serve as indicators of aortic load and valvular gradient, respectively.
  • Transcatheter aortic valve implantation (TAVI) is a treatment option for severe aortic stenosis.

Purpose of the Study:

  • To compare the prognostic impact of TAC and VAC on 3-year cardiovascular (CV) mortality following TAVI.
  • To differentiate the roles of vascular load (TAC) versus valvular gradient (VAC) in LGAS versus high-gradient aortic stenosis (HGAS) patients.

Main Methods:

  • A cohort of 1396 patients undergoing TAVI was analyzed.
  • TAC and VAC were quantified using pre-TAVI computed tomography (CT) scans.
  • Multivariate analysis assessed the association of TAC and VAC with 3-year CV mortality, adjusting for clinical and procedural factors.

Main Results:

  • LGAS patients (31.2%) exhibited higher rates of comorbidities like diabetes, coronary artery disease, and atrial fibrillation compared to HGAS patients.
  • Overall 3-year CV mortality was 17.8%, with higher rates in LGAS (21.6%) vs. HGAS (16.2%).
  • In LGAS, TAC was significantly associated with CV mortality (HR 1.085, P=0.011), whereas VAC was not (HR 0.713, P=0.235).
  • Conversely, in HGAS, VAC was associated with CV mortality (HR 1.342, P=0.027), while TAC was not (HR 1.015, P=0.626).

Conclusions:

  • Thoracic aortic calcifications play a critical prognostic role in LGAS patients undergoing TAVI.
  • Valvular aortic calcifications are the primary predictor of CV mortality in HGAS patients post-TAVI.
  • These findings underscore that LGAS is a complex disease involving both vascular and valvular components.
Abstract

Keywords:
TAVITAVRaortic stiffnessoutcomevascular stiffness

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