title: Aortic Valve Calcium Volume Predicts Paravalvular Regurgitation and the Need for Balloon Post-Dilatation After Transcatheter Aortic Valve Implantation.
abstract: OBJECTIVE
  This study sought to evaluate the impact of aortic valve (AV) and left ventricle outflow tract (LVOT) calcium on paravalvular regurgitation (PVR) and need for balloon post-dilatation (BPD) during transcatheter aortic valve implantation (TAVI).
  
  
  METHODS
  The overall study population comprised 152 patients. Calcium mass and volume of AV and LVOT were estimated from contrast-enhanced multislice computed tomography imaging, using 3 thresholds for calcium detection [650, 850, and 1,050 Hounsfield units (HU)].
  
  
  RESULTS
  A self-expandable prosthesis was implanted in 67.8% of patients and a balloon-expandable prosthesis in the remaining. Eleven patients required BPD and 82 patients presented post-procedural PVR, which was mild in 44.1% and moderate in 9.9%. The greatest discriminatory value for PVR ≥ mild was seen for calcium volume using 850 HU threshold, with an area under the curve of 0.72 (95%CI 0.64-0.80, P < 0.001) for AV and of 0.63 (95%CI 0.54-0.72, P = 0.008) for LVOT. For 850 HU threshold, the calcium volume cut-off with the highest sum of sensitivity and specificity for PVR was 157 mm(3) for AV and 0.6 mm(3) for LVOT. In multivariate logistic regression analysis, the presence of AV calcium ≥157 mm(3) (OR 3.83, 95%CI 1.81-8.10, P < 0.001) and ≥267 mm(3) (OR 11.3, 95%CI 1.2-103.1, P = 0.03) were the only independent predictors of PVR and BPD, respectively.
  
  
  CONCLUSIONS
  AV calcium volume was an independent predictor of PVR and BPD in patients submitted to TAVI. Our results support a systematic assessment of AV calcium volume to identify patients at increased risk of post-procedural PVR.
authors.affiliation: Department of Cardiology, Vila Nova de Gaia Hospital Center, Vila Nova de Gaia, Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Fonseca
authors.affiliation: Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: Bruno
authors.initials: B
authors.lastname: Figueiredo
authors.affiliation: Department of Cardiology, Divino Espírito Santo Hospital, Ponta Delgada, Portugal.
authors.forename: Carla
authors.initials: C
authors.lastname: Almeida
authors.affiliation: Department of Cardiology, Vila Nova de Gaia Hospital Center, Vila Nova de Gaia, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Almeida
authors.affiliation: Department of Cardiology, Vila Nova de Gaia Hospital Center, Vila Nova de Gaia, Portugal.
authors.forename: Nuno
authors.initials: N
authors.lastname: Bettencourt
authors.affiliation: Department of Cardiology, Vila Nova de Gaia Hospital Center, Vila Nova de Gaia, Portugal.
authors.forename: Francisco
authors.initials: F
authors.lastname: Sampaio
authors.affiliation: Department of Cardiology, Vila Nova de Gaia Hospital Center, Vila Nova de Gaia, Portugal.
authors.forename: Nuno
authors.initials: N
authors.lastname: Ferreira
authors.affiliation: Department of Cardiology, Vila Nova de Gaia Hospital Center, Vila Nova de Gaia, Portugal.
authors.forename: Helena
authors.initials: H
authors.lastname: Gonçalves
authors.affiliation: Department of Cardiology, Vila Nova de Gaia Hospital Center, Vila Nova de Gaia, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Braga
authors.affiliation: Department of Cardiology, Vila Nova de Gaia Hospital Center, Vila Nova de Gaia, Portugal.
authors.forename: Vasco Gama
authors.initials: VG
authors.lastname: Ribeiro
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology; D001024:Aortic Valve Stenosis / Q000601:surgery*; D002114:Calcinosis / Q000175:diagnosis*; D002118:Calcium / Q000032:analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods; D011174:Portugal; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome
chemical_list: D002118:Calcium