title: Aortic annulus dimensions and leaflet calcification from contrast MSCT predict the need for balloon post-dilatation after TAVI with the Medtronic CoreValve prosthesis.
abstract: OBJECTIVE
  We compared the measurement of aortic leaflet calcification on contrast and non-contrast MSCT and investigated predictors of the need for balloon post-dilatation after TAVI.
  
  
  RESULTS
  In 110 patients, who had TAVI with a Medtronic CoreValve prosthesis (MCS) for symptomatic aortic stenosis, calcification of the aortic root was measured on non-contrast MSCT (conventionally) and on contrast MSCT (signal attenuation >450 Houndsfield units). Calcium volume was underestimated on contrast- when compared to non-contrast MSCT: median (IQ-range)=759 (466 to 1295) vs. 2016 (1376 to 3262) and the difference between the two methods increased with higher calcium volumes (correlation coefficient r=0.90). Calcium mass was only slightly underestimated on contrast vs. non-contrast MSCT: median (IQ-range)=441 (268 to 809) vs. 555 (341 to 950) and there was no association between the differences and increasing calcium mass (r=0.17). Balloon post-dilatation was performed for significant aortic regurgitation after TAVI in 11 of 110 patients. When compared to controls, the patients who required balloon post-dilatation had higher aortic leaflet calcium on contrast CT (p<0.01), higher aortic annulus diameters (p<0.01) and higher annulus to prosthesis area ratio (p=0.01). ROC curves demonstrated that aortic root or aortic leaflet calcium measured on either contrast- or non-contrast MSCT showed excellent discrimination for the requirement of balloon post-dilatation (area under ROC >0.80 for all), whereas the discriminatory value of aortic annulus dimensions was moderate (area under ROC=0.69) and that of prosthesis to annulus ratio was poor (area under ROC=0.36).
  
  
  CONCLUSIONS
  Dense aortic leaflet calcification measured on contrast MSCT discerned well the need for balloon post-dilatation after TAVI with an MCS for significant PAR. Non-contrast MSCT may no longer be needed to quantify aortic root calcium before TAVI.
authors.affiliation: Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands. c.schultz@erasmucmc.nl
authors.forename: Carl
authors.initials: C
authors.lastname: Schultz
authors.forename: Alexia
authors.initials: A
authors.lastname: Rossi
authors.forename: Nicolas
authors.initials: N
authors.lastname: van Mieghem
authors.forename: Robert
authors.initials: R
authors.lastname: van der Boon
authors.forename: Stella-Lida
authors.initials: SL
authors.lastname: Papadopoulou
authors.forename: Ron
authors.initials: R
authors.lastname: van Domburg
authors.forename: Adriaan
authors.initials: A
authors.lastname: Moelker
authors.forename: Nico
authors.initials: N
authors.lastname: Mollet
authors.forename: Gabriel
authors.initials: G
authors.lastname: Krestin
authors.forename: Robert-Jan
authors.initials: RJ
authors.lastname: van Geuns
authors.forename: Koen
authors.initials: K
authors.lastname: Nieman
authors.forename: Pim
authors.initials: P
authors.lastname: de Feyter
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Peter
authors.initials: P
authors.lastname: de Jaegere
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000628:therapy*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D002114:Calcinosis / Q000000981:diagnostic imaging*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D002404:Catheterization; D003287:Contrast Media; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008297:Male; D009426:Netherlands; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media