title: Prognostic value of aortic root calcification volume on clinical outcomes after transcatheter balloon-expandable aortic valve implantation.
abstract: BACKGROUND
  Few data are available about whether aortic root calcification may impact the outcomes after transcatheter aortic valve implantation (TAVI).
  
  
  OBJECTIVE
  This study sought to evaluate the impact of aortic root calcification volume on clinical outcome after TAVI with balloon expandable Edwards Sapien XT valve (Edwards Lifesciences, Irvine, California).
  
  
  METHODS
  A total of 162 TAVI patients (aged 84.0 [Interquartile Range (IQR) 81.0-84.0] years, Logistic EuroSCORE 14.5 [IQR 9.8-25.1]) with preprocedural MDCT were studied. Aortic root calcification volume was measured by MDCT image and using the dedicated software for aortic valve assessment (the automated 3mensio™ Valves 5.1, sp1, 3mensio Pie Medical Imaging BV, Maastricht, the Netherlands). A valve calcification index (VCI) was defined as calcification volume (mm(3))/body surface area (mm(2)).
  
  
  RESULTS
  VCI was significantly higher among patients with 30-day mortality. A VCI threshold of 517.4 (area under the curve 0.69, 95% CI 0.50-0.87, P = 0.03) predicted a higher incidence of annulus rupture (9.1 vs. 0.9%, P = 0.02) and cardiac tamponade (12.7 vs. 1.9%, P < 0.01), lower device success (83.6% vs. 95.3%, P < 0.01) and 30-day survival rate (80.0% vs. 97.2%, P < 0.01). Multivariate logistic regression analysis showed only ejection fraction and VCI were identified as independent predictors of 30-day mortality (Odds ratio 0.948 [95% confidence interval 0.909-0.988], P = 0.012, Odds ratio 1.003 [95% confidence interval 1.001-1.005], P = 0.013, respectively).
  
  
  CONCLUSIONS
  Significantly worse acute clinical outcomes after Edwards valve implantation were observed in patients with large amount of aortic annulus calcifications quantitatively measured by dedicated MDCT software. Application of VCI may prove helpful in prediction of clinical outcomes after TAVI.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan.|Department of Cardiology and Cardiovascular Surgery, Institut Cardiovasculaire Paris Sud, Orsay, France.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Department of Cardiology and Cardiovascular Surgery, Institut Cardiovasculaire Paris Sud, Orsay, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Lefèvre
authors.affiliation: Department of Cardiology and Cardiovascular Surgery, Institut Cardiovasculaire Paris Sud, Orsay, France.
authors.forename: Erik
authors.initials: E
authors.lastname: Bouvier
authors.affiliation: Department of Cardiology and Cardiovascular Surgery, Institut Cardiovasculaire Paris Sud, Orsay, France.
authors.forename: Takahide
authors.initials: T
authors.lastname: Arai
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Hayashida
authors.affiliation: Department of Cardiology and Cardiovascular Surgery, Institut Cardiovasculaire Paris Sud, Orsay, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Chevalier
authors.affiliation: Department of Cardiology and Cardiovascular Surgery, Institut Cardiovasculaire Paris Sud, Orsay, France.
authors.forename: Mauro
authors.initials: M
authors.lastname: Romano
authors.affiliation: Department of Cardiology and Cardiovascular Surgery, Institut Cardiovasculaire Paris Sud, Orsay, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hovasse
authors.affiliation: Department of Cardiology and Cardiovascular Surgery, Institut Cardiovasculaire Paris Sud, Orsay, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Garot
authors.affiliation: Department of Cardiology and Cardiovascular Surgery, Institut Cardiovasculaire Paris Sud, Orsay, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Donzeau-Gouge
authors.affiliation: Department of Cardiology and Cardiovascular Surgery, Institut Cardiovasculaire Paris Sud, Orsay, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Farge
authors.affiliation: Department of Cardiology and Cardiovascular Surgery, Institut Cardiovasculaire Paris Sud, Orsay, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Cormier
authors.affiliation: Department of Cardiology and Cardiovascular Surgery, Institut Cardiovasculaire Paris Sud, Orsay, France.
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Morice
mesh_terms: D000369:Aged, 80 and over; D000704:Analysis of Variance; D001021:Aortic Valve / Q000473:pathology; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D002114:Calcinosis / Q000175:diagnosis* / Q000401:mortality; D002423:Cause of Death; D015331:Cohort Studies; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods; D015999:Multivariate Analysis; D009426:Netherlands; D012044:Regression Analysis; D012189:Retrospective Studies; D016019:Survival Analysis; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
keywords: annulus rupture; balloon-expandable valve; calcification; multislice computed tomography; transcatheter aortic valve implantation