title: Aortic valve calcium score as a predictor for outcome after TAVI using the CoreValve revalving system.
abstract: BACKGROUND
  TAVI is a novel treatment option for patients at too high risk for surgery. Risk scores for surgical valve replacement failed to accurately predict outcomes after TAVI and alternative risk parameters are lacking so far.
  
  
  OBJECTIVE
  We evaluated the CT-derived aortic valve calcification score as a predictor for outcome during and after TAVI.
  
  
  METHODS
  Transfemoral TAVI using the CoreValve device was performed in 68 patients, in whom the aortic valve calcium score was determined from preprocedural 64-sclice ECG gated CT-scans.
  
  
  RESULTS
  30-day MACE rate (death, stroke, MI) was 10.3%, 1-year mortality was 11.8%. Using linear regression analysis the aortic valve calcium score was the only significant predictor for 30-day MACE and for 1-year mortality and was also associated with the incidence and severity of post procedural aortic regurgitation (r=0.33, p<0.05). Patients withvalve calcium scores >750 had a significant lower 1-year survival rate compared to patients with scores <750 (58% vs. 98%, p<0.05). The aortic valve calcium score is also inversely associated with the absolute improvement of NYHA-class after TAVI (regression coefficient=-0.43, p<0.02).
  
  
  CONCLUSIONS
  The degree of aortic valve calcification is associated with post procedural aortic regurgitation, procedural complications, 1-year mortality and with the degree of functional improvement of patients who underwent TAVI using the CoreValve device. Due to the fact that the aortic valve calcium score can be determined from CT-datasets that are used for preprocedural planning, this parameter may be incorporated in the general work up and may be used for risk stratification and patient selection.
authors.affiliation: Department of Cardiology, Heart Center Bogenhausen, Klinikum München Bogenhausen, Technical University of Munich, Germany. leber@heart-center-muc.de
authors.forename: Alexander W
authors.initials: AW
authors.lastname: Leber
authors.forename: Markus
authors.initials: M
authors.lastname: Kasel
authors.forename: Thomas
authors.initials: T
authors.lastname: Ischinger
authors.forename: Ulrich H
authors.initials: UH
authors.lastname: Ebersberger
authors.forename: Diethmar
authors.initials: D
authors.lastname: Antoni
authors.forename: Martin
authors.initials: M
authors.lastname: Schmidt
authors.forename: Gotthard
authors.initials: G
authors.lastname: Riess
authors.forename: Vivian
authors.initials: V
authors.lastname: Renz
authors.forename: Armin
authors.initials: A
authors.lastname: Huber
authors.forename: Thomas
authors.initials: T
authors.lastname: Helmberger
authors.forename: Ellen
authors.initials: E
authors.lastname: Hoffmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D016896:Treatment Outcome