title: The aortic valve calcium nodule score (AVCNS) independently predicts paravalvular regurgitation after transcatheter aortic valve replacement (TAVR).
abstract: BACKGROUND
  Paravalvular regurgitation (PVR) is an important predictor of mortality after transcatheter aortic valve replacement (TAVR). Aortic valve (AV) calcification is strongly associated with PVR.
  
  
  OBJECTIVE
  This study proposes a new metric to quantify AV total calcium burden and its composition in large calcium nodules (CNs) and explores its relation with PVR after TAVR.
  
  
  METHODS
  In 133 patients that underwent TAVR, calcium burden of the AV was quantified with multidetector row CT as calcium mass. Each CN was characterized. The AV CN score (AVCNS) was defined as AV calcium mass × mass of the largest CN. PVR was assessed with echocardiography at 1 month. Logistic regression analysis was conducted to identify predictors of PVR.
  
  
  RESULTS
  Mean age was 84.1 ± 7.6 years (56% women). TAVR access was transapical in 56%. Procedural success was achieved in 92%. In-hospital mortality was 5%. At follow-up, the prevalence of absent/trace, mild, moderate, and severe PVR was 58%, 31%, 11%, and 0%, respectively. The only independent predictors of at least mild PVR were AVCNS (odds ratio [OR], 2.269; 95% CI, 1.433-3.593; P < .001), number of CNs on aortic annulus (OR, 1.822; 95% CI, 1.137-2.921; P = .013), and aortic annulus area (OR, 1.112; 95% CI, 1.010-1.223; P = .030). This model showed an area under the curve of 0.895 (95% CI, 0.830-0.960) for PVR prediction.
  
  
  CONCLUSIONS
  AVCNS, a variable that comprises the total burden of AV calcification as well as calcification agglomeration in form of large nodules, is a novel and powerful independent predictor of PVR after TAVR.
authors.affiliation: Cardiac Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Interventional Cardiology, Heart Center, Massachusetts General Hospital, Boston, MA, USA; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Azzalini
authors.affiliation: Cardiac Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Brian B
authors.initials: BB
authors.lastname: Ghoshhajra
authors.affiliation: Interventional Cardiology, Heart Center, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Sammy
authors.initials: S
authors.lastname: Elmariah
authors.affiliation: Interventional Echocardiography, Heart Center, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Passeri
authors.affiliation: Interventional Cardiology, Heart Center, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Inglessis
authors.affiliation: Interventional Cardiology, Heart Center, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Igor F
authors.initials: IF
authors.lastname: Palacios
authors.affiliation: Cardiac Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address: Suhny.Abbara@utsouthwestern.edu.
authors.forename: Suhny
authors.initials: S
authors.lastname: Abbara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D019540:Area Under Curve; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000401:mortality; D018618:Echocardiography, Doppler, Color; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D061330:Multidetector Computed Tomography; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: Aortic valve; Calcification; Calcium; Computed tomography; Paravalvular regurgitation; Transcatheter aortic valve replacement