Abstract 12199: Impact of Aortic Valve Calcification Severity and Impaired Left Ventricular Function on Three-Year Results of Patients Undergoing Transcatheter Aortic Valve Replacement
Introduction: Transcatheter aortic valve replacement (TAVI) has been established in high-risk patients with severe aortic valve stenosis. We aimed to evaluate clinical predictors of three-year outcome and mortality in a real-world population treated with TAVI.
Methods: Consecutive patients with symptomatic aortic valve stenosis (aortic valve area ≤ 1cm2 ) undergoing TAVI were prospectively included into the Aachen TAVI registry. Among 326 patients, 61 patients (25 men, mean age 81 ± 6 years, logistic EuroSCORE of 21 ± 13) with a baseline dual-source computed tomography (DSCT) and a mean follow-up of 35 ± 6 months were identified. Prior to TAVI, all patients received an echocardiography and underwent a non-enhanced and contrast-enhanced DSCT (Definition, Siemens, Forchheim, Germany with scan parameters as follows: 2x64x0,6mm collimation, tube voltage 120KV, 380mAs tube current) for quantification of aortic valve calcification (AVC) severity using the Agatston AVC score. Mortality tracking was achieved in 100% of patients.
Results: Survival at 30 days was 89 %, and it was 59% at 2 years. NYHA class showed a marked improvement from 3.2 ± 0.6 at baseline to 1.4 ± 0.6 at 3 years. Non-survivors at 3 years showed a significantly higher Agatston AVC score (2756 ± 1679) than survivors (2005 ± 1001, p=0.03). Multivariate analysis including age, logistic EuroScore, glomerular filtration rate, Agatston AVC score, ejection fraction < 40% and NYHA class revealed that only the Agatston AVC score (p=0.028) and impaired left ventricular function (p=0.007) was significantly associated with mortality.
Conclusions: The results of this study suggest that aortic valve calcification severity and impaired left ventricular function may serve as a predictor of long-term mortality. TAVI can improve NYHA class in high-risk patients with severe aortic valve stenosis that can be maintained thru 3 years in survivors.
- © 2012 by American Heart Association, Inc.