Aortic valve and left ventricular outflow tract calcium volume and distribution in transcatheter aortic valve replacement: Influence on the risk of significant paravalvular regurgitation

Nicolaj C Hansson; Jonathon Leipsic; Francesca Pugliese; Henning R Andersen; Alexia Rossi; Matheus Simonato; Kaare T Jensen; Evald H Christiansen; Christian J Terkelsen; Philipp Blanke; Mariann Tang; Lars R Krusell; Kaj-Erik Klaaborg; Kim Terp; Simon Kennon; Danny Dvir; Hans Erik Bøtker; John Webb; Bjarne L Nørgaard

doi:10.1016/j.jcct.2018.02.002

Aortic valve and left ventricular outflow tract calcium volume and distribution in transcatheter aortic valve replacement: Influence on the risk of significant paravalvular regurgitation

Nicolaj C Hansson, Jonathon Leipsic, Francesca Pugliese, Henning R Andersen, Alexia Rossi, Matheus Simonato, Kaare T Jensen, Evald H Christiansen, Christian J Terkelsen, Philipp Blanke, Mariann Tang, Lars R Krusell, Kaj-Erik Klaaborg, Kim Terp, Simon Kennon, Danny Dvir, Hans Erik Bøtker, John Webb, Bjarne L Nørgaard

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

37 Citationer (Scopus)

Abstract

Objectives: We sought to determine the impact of aortic root calcium on the risk of significant paravalvular regurgitation (sPAR) in transcatheter aortic valve replacement (TAVR). Methods: In 302 consecutive patients from 3 centers, aortic root calcium was quantified volumetrically on pre-TAVR multidetector computed tomography (MDCT) in three regions: 1) the aortic valve region, 2) the overall left ventricular outflow tract (LVOT) and 3) the upper LVOT. Transcathether heart valve (THV) oversizing was calculated as (THV nominal area/MDCT annular area−1) × 100. The study endpoint sPAR was a composite of post-dilatation (PD) and PAR > mild. Results: sPAR occurred in 15% (46/302) of patients. Upper LVOT calcium volume was more predictive of sPAR than overall LVOT calcium volume, with an area under the receiver operating curve (AUC) (95% confidence interval [CI]) of 0.80 (0.67–0.89) vs. 0.60 (0.51–0.70); p = 0.0001. The optimal cut-off calcium volume thresholds determined from receiver operating curves were 21 mm ³ and 30 mm ³ for upper LVOT and overall LVOT calcium, respectively. Upper LVOT calcium ≥ 21 mm ³, but not overall LVOT calcium ≥ 30 mm ³, independently predicted sPAR, odds ratio (95%CI): 9.5 (4.1–22.3) vs 1.6 (0.6–2.7). Upper LVOT calcium was more predictive of sPAR in patients with THV oversizing ≥ 13% compared to patients with THV oversizing <13%, AUC (95% CI): 0.83 (0.72–0.93) vs. 0.67 (0.51–0.74); p < 0.0001. Conclusions: Upper LVOT calcium predicts more-than-mild paravalvular regurgitation following TAVR or the need for postdilatation. Upper LVOT calcium is most predictive of paravalvular regurgitation in the event of THV oversizing ≥ 13%.

Originalsprog	Engelsk
Tidsskrift	Journal of Cardiovascular Computed Tomography
Vol/bind	12
Nummer	4
Sider (fra-til)	290-297
Antal sider	8
ISSN	1934-5925
DOI	https://doi.org/10.1016/j.jcct.2018.02.002
Status	Udgivet - 1 jul. 2018

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Hansson, N. C., Leipsic, J., Pugliese, F., Andersen, H. R., Rossi, A., Simonato, M., Jensen, K. T., Christiansen, E. H., Terkelsen, C. J., Blanke, P., Tang, M., Krusell, L. R., Klaaborg, K.-E., Terp, K., Kennon, S., Dvir, D., Bøtker, H. E., Webb, J., & Nørgaard, B. L. (2018). Aortic valve and left ventricular outflow tract calcium volume and distribution in transcatheter aortic valve replacement: Influence on the risk of significant paravalvular regurgitation. Journal of Cardiovascular Computed Tomography, 12(4), 290-297. https://doi.org/10.1016/j.jcct.2018.02.002

@article{837b3d9b76fb4ef484a87d30a88768de,

title = "Aortic valve and left ventricular outflow tract calcium volume and distribution in transcatheter aortic valve replacement: Influence on the risk of significant paravalvular regurgitation",

abstract = "Objectives: We sought to determine the impact of aortic root calcium on the risk of significant paravalvular regurgitation (sPAR) in transcatheter aortic valve replacement (TAVR). Methods: In 302 consecutive patients from 3 centers, aortic root calcium was quantified volumetrically on pre-TAVR multidetector computed tomography (MDCT) in three regions: 1) the aortic valve region, 2) the overall left ventricular outflow tract (LVOT) and 3) the upper LVOT. Transcathether heart valve (THV) oversizing was calculated as (THV nominal area/MDCT annular area−1) × 100. The study endpoint sPAR was a composite of post-dilatation (PD) and PAR > mild. Results: sPAR occurred in 15% (46/302) of patients. Upper LVOT calcium volume was more predictive of sPAR than overall LVOT calcium volume, with an area under the receiver operating curve (AUC) (95% confidence interval [CI]) of 0.80 (0.67–0.89) vs. 0.60 (0.51–0.70); p = 0.0001. The optimal cut-off calcium volume thresholds determined from receiver operating curves were 21 mm 3 and 30 mm 3 for upper LVOT and overall LVOT calcium, respectively. Upper LVOT calcium ≥ 21 mm 3, but not overall LVOT calcium ≥ 30 mm 3, independently predicted sPAR, odds ratio (95%CI): 9.5 (4.1–22.3) vs 1.6 (0.6–2.7). Upper LVOT calcium was more predictive of sPAR in patients with THV oversizing ≥ 13% compared to patients with THV oversizing <13%, AUC (95% CI): 0.83 (0.72–0.93) vs. 0.67 (0.51–0.74); p < 0.0001. Conclusions: Upper LVOT calcium predicts more-than-mild paravalvular regurgitation following TAVR or the need for postdilatation. Upper LVOT calcium is most predictive of paravalvular regurgitation in the event of THV oversizing ≥ 13%.",

keywords = "Aortic valve insufficiency, Echocardiography, Heart valve prosthesis, Multidetector computed tomography, Transcatheter aortic valve replacement",

author = "Hansson, {Nicolaj C} and Jonathon Leipsic and Francesca Pugliese and Andersen, {Henning R} and Alexia Rossi and Matheus Simonato and Jensen, {Kaare T} and Christiansen, {Evald H} and Terkelsen, {Christian J} and Philipp Blanke and Mariann Tang and Krusell, {Lars R} and Kaj-Erik Klaaborg and Kim Terp and Simon Kennon and Danny Dvir and B{\o}tker, {Hans Erik} and John Webb and N{\o}rgaard, {Bjarne L}",

note = "Copyright {\textcopyright} 2018. Published by Elsevier Inc.",

year = "2018",

month = jul,

day = "1",

doi = "10.1016/j.jcct.2018.02.002",

language = "English",

volume = "12",

pages = "290--297",

journal = "Journal of Cardiovascular Computed Tomography",

issn = "1934-5925",

publisher = "Elsevier Inc.",

number = "4",

}

Hansson, NC, Leipsic, J, Pugliese, F, Andersen, HR, Rossi, A, Simonato, M, Jensen, KT, Christiansen, EH , Terkelsen, CJ, Blanke, P, Tang, M, Krusell, LR, Klaaborg, K-E, Terp, K, Kennon, S, Dvir, D, Bøtker, HE, Webb, J & Nørgaard, BL 2018, 'Aortic valve and left ventricular outflow tract calcium volume and distribution in transcatheter aortic valve replacement: Influence on the risk of significant paravalvular regurgitation', Journal of Cardiovascular Computed Tomography, bind 12, nr. 4, s. 290-297. https://doi.org/10.1016/j.jcct.2018.02.002

Aortic valve and left ventricular outflow tract calcium volume and distribution in transcatheter aortic valve replacement: Influence on the risk of significant paravalvular regurgitation. / Hansson, Nicolaj C; Leipsic, Jonathon; Pugliese, Francesca et al.
I: Journal of Cardiovascular Computed Tomography, Bind 12, Nr. 4, 01.07.2018, s. 290-297.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

TY - JOUR

T1 - Aortic valve and left ventricular outflow tract calcium volume and distribution in transcatheter aortic valve replacement

T2 - Influence on the risk of significant paravalvular regurgitation

AU - Hansson, Nicolaj C

AU - Leipsic, Jonathon

AU - Pugliese, Francesca

AU - Andersen, Henning R

AU - Rossi, Alexia

AU - Simonato, Matheus

AU - Jensen, Kaare T

AU - Christiansen, Evald H

AU - Terkelsen, Christian J

AU - Blanke, Philipp

AU - Tang, Mariann

AU - Krusell, Lars R

AU - Klaaborg, Kaj-Erik

AU - Terp, Kim

AU - Kennon, Simon

AU - Dvir, Danny

AU - Bøtker, Hans Erik

AU - Webb, John

AU - Nørgaard, Bjarne L

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Objectives: We sought to determine the impact of aortic root calcium on the risk of significant paravalvular regurgitation (sPAR) in transcatheter aortic valve replacement (TAVR). Methods: In 302 consecutive patients from 3 centers, aortic root calcium was quantified volumetrically on pre-TAVR multidetector computed tomography (MDCT) in three regions: 1) the aortic valve region, 2) the overall left ventricular outflow tract (LVOT) and 3) the upper LVOT. Transcathether heart valve (THV) oversizing was calculated as (THV nominal area/MDCT annular area−1) × 100. The study endpoint sPAR was a composite of post-dilatation (PD) and PAR > mild. Results: sPAR occurred in 15% (46/302) of patients. Upper LVOT calcium volume was more predictive of sPAR than overall LVOT calcium volume, with an area under the receiver operating curve (AUC) (95% confidence interval [CI]) of 0.80 (0.67–0.89) vs. 0.60 (0.51–0.70); p = 0.0001. The optimal cut-off calcium volume thresholds determined from receiver operating curves were 21 mm 3 and 30 mm 3 for upper LVOT and overall LVOT calcium, respectively. Upper LVOT calcium ≥ 21 mm 3, but not overall LVOT calcium ≥ 30 mm 3, independently predicted sPAR, odds ratio (95%CI): 9.5 (4.1–22.3) vs 1.6 (0.6–2.7). Upper LVOT calcium was more predictive of sPAR in patients with THV oversizing ≥ 13% compared to patients with THV oversizing <13%, AUC (95% CI): 0.83 (0.72–0.93) vs. 0.67 (0.51–0.74); p < 0.0001. Conclusions: Upper LVOT calcium predicts more-than-mild paravalvular regurgitation following TAVR or the need for postdilatation. Upper LVOT calcium is most predictive of paravalvular regurgitation in the event of THV oversizing ≥ 13%.

AB - Objectives: We sought to determine the impact of aortic root calcium on the risk of significant paravalvular regurgitation (sPAR) in transcatheter aortic valve replacement (TAVR). Methods: In 302 consecutive patients from 3 centers, aortic root calcium was quantified volumetrically on pre-TAVR multidetector computed tomography (MDCT) in three regions: 1) the aortic valve region, 2) the overall left ventricular outflow tract (LVOT) and 3) the upper LVOT. Transcathether heart valve (THV) oversizing was calculated as (THV nominal area/MDCT annular area−1) × 100. The study endpoint sPAR was a composite of post-dilatation (PD) and PAR > mild. Results: sPAR occurred in 15% (46/302) of patients. Upper LVOT calcium volume was more predictive of sPAR than overall LVOT calcium volume, with an area under the receiver operating curve (AUC) (95% confidence interval [CI]) of 0.80 (0.67–0.89) vs. 0.60 (0.51–0.70); p = 0.0001. The optimal cut-off calcium volume thresholds determined from receiver operating curves were 21 mm 3 and 30 mm 3 for upper LVOT and overall LVOT calcium, respectively. Upper LVOT calcium ≥ 21 mm 3, but not overall LVOT calcium ≥ 30 mm 3, independently predicted sPAR, odds ratio (95%CI): 9.5 (4.1–22.3) vs 1.6 (0.6–2.7). Upper LVOT calcium was more predictive of sPAR in patients with THV oversizing ≥ 13% compared to patients with THV oversizing <13%, AUC (95% CI): 0.83 (0.72–0.93) vs. 0.67 (0.51–0.74); p < 0.0001. Conclusions: Upper LVOT calcium predicts more-than-mild paravalvular regurgitation following TAVR or the need for postdilatation. Upper LVOT calcium is most predictive of paravalvular regurgitation in the event of THV oversizing ≥ 13%.

KW - Aortic valve insufficiency

KW - Echocardiography

KW - Heart valve prosthesis

KW - Multidetector computed tomography

KW - Transcatheter aortic valve replacement

UR - http://www.scopus.com/inward/record.url?scp=85042850288&partnerID=8YFLogxK

U2 - 10.1016/j.jcct.2018.02.002

DO - 10.1016/j.jcct.2018.02.002

M3 - Journal article

C2 - 29519754

SN - 1934-5925

VL - 12

SP - 290

EP - 297

JO - Journal of Cardiovascular Computed Tomography

JF - Journal of Cardiovascular Computed Tomography

IS - 4

ER -

Aortic valve and left ventricular outflow tract calcium volume and distribution in transcatheter aortic valve replacement: Influence on the risk of significant paravalvular regurgitation

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