Abstract 9436: Impact of Aortic Valve Calcification Severity and Impaired Left Ventricular Function on Long-Term Outcome After Transcatheter Aortic Valve Replacement: 24 Months Results From the Aachen Registry
Introduction: Transcatheter aortic valve replacement (TAVI) has been established in high-risk patients with severe aortic valve stenosis. We aimed to evaluate pre-interventional clinical predictors of two-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 346 patients, 105 patients (34 men, mean age 81 ± 6 years, logistic EuroSCORE of 21 ± 12) with a baseline dual-source computed tomography (DSCT) and a two-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 90 %, and it was 63% at 2 years. NYHA class showed a marked improvement from 3.2 ± 0.6 at baseline to 1.4 ± 0.6 at 2 years. Non-survivors at 2 years showed a significantly higher Agatston AVC score (2722 ± 1485) than survivors (1809 ± 997, p=0.001). 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<0.001) and impaired left ventricular function (p=0.021) was significantly associated with mortality. Patients with Agatston AVC scores > 1900 (above the median of the total cohort) had a significantly lower 2-year survival rate compared to patients with scores < 1900 (47% vs. 78%, p=0.001).
Conclusions: In patients referred for TAVI, aortic valve calcification severity and impaired left ventricular function 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.