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Evaluation of aortic arch calcification to predict prognosis after transcatheter aortic valve replacement
Dao Zhou1,2, Hanyi Dai1,2, Wenjing Sheng1,2
1Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China.
Insights
A new rapid method effectively evaluates aortic arch calcification (AAC) in transcatheter aortic valve replacement (TAVR) patients. Moderate to severe AAC independently predicts higher 3-year mortality, highlighting its prognostic value.
Area of Science:
- Cardiology
- Radiology
- Medical Prognostics
Background:
- Aortic arch calcification (AAC) assessment lacks routine reporting due to ineffective methods.
- The prognostic significance of AAC in transcatheter aortic valve replacement (TAVR) patients remains unclear.
Purpose of the Study:
- To develop a rapid, reproducible method for evaluating AAC in TAVR patients.
- To investigate the association between AAC and clinical prognosis after TAVR.
Main Methods:
- A cohort of 464 patients undergoing TAVR for aortic stenosis was analyzed.
- A novel semi-quantitative method was employed for AAC evaluation.
- Survival analysis, including Cox regression, assessed the impact of AAC on mortality.
Main Results:
- Higher AAC severity correlated with increased 3-year all-cause mortality (p < 0.001).
- Severe AAC predicted higher cardiovascular and non-cardiovascular mortality.
- Moderate/severe AAC independently predicted 3-year all-cause mortality (HR: 1.78, p = 0.037).
Conclusions:
- The developed rapid AAC evaluation method is reproducible and suitable for TAVR patients.
- AAC is a significant independent predictor of mortality following TAVR.
- Routine AAC assessment can aid in stratifying TAVR patient prognosis.
Abstract:
Few centers routinely report aortic arch calcification (AAC) due to the lack of an easy and effective evaluation method. The association between AAC and the clinical prognosis of patients who undergo transcatheter aortic valve replacement (TAVR) is unclear. We aimed to develop a rapid method to evaluate AAC in patients who underwent TAVR and to further assess their prognosis. We enrolled 464 consecutive patients with aortic stenosis who underwent TAVR. Patients with severe (11.2%), moderate (18.5%), mild (58.2%), and no (12.1%) AAC had an estimated 3-year all-cause mortality incidence of 39.6%, 20.8%, 13.4%, and 6.7% (log rank p < 0.001), respectively. Patients with severe AAC had a significantly higher incidence of both cardiovascular (log rank p = 0.002) and non-cardiovascular mortality (log rank p = 0.009), whereas patients with moderate AAC had a higher incidence of only non-cardiovascular mortality (p = 0.003) compared with patients with no/mild AAC. Moderate/severe AAC was an independent predictor of 3-year all-cause mortality in univariate (hazard ratio [HR]: 2.39, 95% confidence interval [CI]: 1.41-4.03; p = 0.001) and multivariate COX regression analyses (HR: 1.78, 95%CI: 1.04-3.06; p = 0.037). Our rapid semi-quantitative method to evaluate AAC is highly reproducible and can be used to assess AAC in patients who undergo TAVR.
