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Association of aortic valvular complex calcification burden with procedural and long-term clinical outcomes after

Euihong Ko1, Do-Yoon Kang1, Jung-Min Ahn1

  • 1Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.

European Heart Journal. Cardiovascular Imaging
|September 7, 2021
PubMed

Insights

Higher valvular/subvalvular calcium burden in transcatheter aortic valve replacement (TAVR) patients correlated with increased paravalvular leakage and pacemaker needs. However, adjusted long-term composite outcomes and mortality risks were not significantly affected by calcium levels.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Imaging

Background:

  • Severe aortic stenosis (AS) necessitates intervention, with transcatheter aortic valve replacement (TAVR) being a primary treatment.
  • Valvular and subvalvular calcification are common in AS patients undergoing TAVR.
  • The prognostic impact of baseline calcium burden on TAVR outcomes requires further elucidation.

Purpose of the Study:

  • To evaluate the association between valvular/subvalvular calcium burden and procedural/long-term outcomes following TAVR.
  • To stratify patients based on calcium volume tertiles and assess their clinical trajectories.

Main Methods:

  • Prospective observational cohort study of 676 AS patients undergoing TAVR (March 2010-December 2019).
  • Baseline calcium burden quantified via multidetector computed tomography and categorized into tertiles.
  • Procedural outcomes (paravalvular leakage, permanent pacemaker insertion) and 12-month clinical outcomes (composite of death, stroke, rehospitalization; all-cause mortality) were analyzed.

Main Results:

  • Moderate/severe paravalvular leakage and permanent pacemaker insertion rates increased proportionally with higher calcium tertiles (P-for-trend < 0.05).
  • The 12-month composite outcome rate was significantly different across tertiles (log-rank P = 0.02), but multivariable analysis showed no significant difference in adjusted risks (middle-tertile HR 0.81; high-tertile HR 0.93).
  • All-cause mortality followed a similar pattern, with no significant adjusted differences between calcium groups.

Conclusions:

  • While increased valvular/subvalvular calcium burden is associated with higher rates of procedural complications like paravalvular leakage and permanent pacemaker insertion, it does not appear to significantly impact adjusted 12-month composite outcomes or all-cause mortality after TAVR.
  • Calcium burden assessment may inform procedural risk stratification but does not appear to be an independent predictor of long-term adverse events in this cohort.
Abstract

Keywords:
aortic valvescalciummortalitytranscatheter aortic valve replacement

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