title: Location and severity of aortic valve calcium and implications for aortic regurgitation after transcatheter aortic valve implantation.
abstract: Location of aortic valve calcium (AVC) can be better visualized on contrast-enhanced multidetector row computed tomography. The present evaluation examined whether AVC severity and its location could influence paravalvular aortic regurgitation (AR) after transcatheter aortic valve implantation. A total of 79 patients (age 80 ± 7 years, 49% men) with preprocedural multidetector row computed tomography were included. Volumetric AVC quantification and its location were assessed. Transesophageal echocardiography was performed to assess the presence and site of AR after transcatheter aortic valve implantation. Receiver operating characteristic curves were generated to evaluate the usefulness of AVC in determining paravalvular AR at a specific site. Postprocedural AR of grade 1 or more was observed in 63 patients. In most patients (n = 56, 71%), AR was of paravalvular origin. Calcium at the aortic wall of each valve cusp had the largest area under the curve (0.93, p <0.001) in predicting paravalvular AR at the aortic wall site compared to calcium at the valvular edge or body (area under the curve 0.58 and 0.67, respectively). Calcium at the valvular commissure was better than calcium at the valvular edge (area under the curve 0.94 vs 0.71) in predicting paravavular AR originating from the corresponding commissure. In conclusion, contrast-enhanced multidetector row computed tomography can be performed to quantify AVC. Both AVC severity and its exact location are important in determining paravalvular AR after transcatheter aortic valve implantation.
authors.affiliation: Department of Cardiology and Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: See Hooi
authors.initials: SH
authors.lastname: Ewe
authors.forename: Arnold C T
authors.initials: AC
authors.lastname: Ng
authors.forename: Joanne D
authors.initials: JD
authors.lastname: Schuijf
authors.forename: Frank
authors.initials: F
authors.lastname: van der Kley
authors.forename: Andrea
authors.initials: A
authors.lastname: Colli
authors.forename: Meindert
authors.initials: M
authors.lastname: Palmen
authors.forename: Arend
authors.initials: A
authors.lastname: de Weger
authors.forename: Nina Ajmone
authors.initials: NA
authors.lastname: Marsan
authors.forename: Eduard R
authors.initials: ER
authors.lastname: Holman
authors.forename: Albert
authors.initials: A
authors.lastname: de Roos
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000145:classification / Q000000981:diagnostic imaging* / Q000209:etiology; D001024:Aortic Valve Stenosis / Q000601:surgery; D003287:Contrast Media; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography; D011300:Preoperative Care; D011446:Prospective Studies; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018615:Ultrasonography, Doppler, Color; D018617:Ultrasonography, Doppler, Pulsed; D061205:Vascular Calcification / Q000000981:diagnostic imaging*
chemical_list: D003287:Contrast Media