Abstract 10593: Impact of Aortic Valve Calcification Severity on Four-Year Results of Patients Undergoing Transcatheter Aortic Valve Replacement
Introduction: Transcatheter aortic valve implantation (TAVI) has been established in high-risk patients with severe aortic valve stenosis. We aimed to evaluate clinical pre-interventional predictors of four-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 367 patients, 57 patients (mean age 81 ± 6 years, logistic EuroSCORE of 21 ± 12) with a baseline dual-source computed tomography (DSCT) for quantification of aortic valve calcification (AVC) and a four-year follow-up 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 91%, and it was 75%, 66%, 64% and 54% at 1, 2, 3 years and 4 years, respectively. NYHA class showed a marked improvement from 3.1 ± 0.6 at baseline to 1.4 ± 0.6 at 4 years. Non-survivors at 4 years showed a significantly higher Agatston AVC score (2614 ± 1700) than survivors (1840 ± 984, p=0.04). Multivariate analysis including age, logistic EuroScore, glomerular filtration rate, Agatston AVC score, ejection fraction < 40% NYHA class and chronic lung disease revealed that only the Agatston AVC score (p=0.03) was significantly associated with mortality. Patients with Agatston AVC scores > 1900 (above the median of the cohort) had a significantly lower 4-year survival rate compared to patients with scores < 1900 (38% vs. 67%, p=0.03).
Conclusions: In patients referred for TAVI, aortic valve calcification severity may serve as a predictor of long-term mortality. Therefore, aortic valve calcification scores easily to be determined from preprocedural CT-datasets may be used for patient risk stratification.
- © 2013 by American Heart Association, Inc.