title: Aorta calcification burden: Towards an integrative predictor of cardiac outcome after transcatheter aortic valve implantation.
abstract: OBJECTIVE
  The principal objective was to determine the effect of total aortic calcification (TAC) burden on outcomes (cardiac mortality, all-cause mortality, and heart failure (HF)) after transcatheter aortic valve implantation (TAVI). The secondary aim was to assess the contribution of each segment of the aorta to these outcomes.
  
  
  BACKGROUND
  Indications for TAVI are increasing in number. Even after procedural success, however, some patients die soon afterwards, indicating the futility of TAVI in certain cases.
  
  
  METHODS
  Aortic calcifications were measured on computed tomography in 164 patients treated by TAVI. TAC, ascending aortic calcification (AsAC), descending aorta calcifications, and abdominal aorta calcifications were expressed as tertiles and their prognostic values were assessed in a multivariable cox analysis adjusted for major confounders including EuroSCORE.
  
  
  RESULTS
  Median duration of follow-up was 565 (interquartile range: 246 to 1000) days. TAC (tertile3 vs. tertile1) was significantly and strongly associated with cardiac mortality (hazard ratio [HR]: 16.74; 95% confidence interval [CI]: 2.21 to 127.05; p = 0.006) and all-cause mortality (HR: 2.39; 95% CI: 1.18 to 4.84; p = 0.015) but not with HF (HR: 1.84; 95% CI: 0.87 to 3.90; p = 0.110). Each segment was associated with cardiac mortality, while only AsAC (tertile 3 vs. tertile 1) appeared predictive of HF (hazard ratio: 2.29; 95% CI: 1.12 to 4.66; p = 0.023).
  
  
  CONCLUSIONS
  TAC is an integrative predictor of cardiac and all-cause mortality after TAVI. It should be included in the assessment of patients before TAVI in order to predict cardiac outcome after valve replacement and avoid futile interventions.
authors.affiliation: From the Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France; Université de Lyon, CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, France. Electronic address: bharbaoui@gmail.com.
authors.forename: Brahim
authors.initials: B
authors.lastname: Harbaoui
authors.affiliation: From the Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Montoy
authors.affiliation: From the Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Charles
authors.affiliation: Université de Lyon, CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, France; Radiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France.
authors.forename: Loic
authors.initials: L
authors.lastname: Boussel
authors.affiliation: Université de Lyon, CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Liebgott
authors.affiliation: INSERM, Centre d'Investigations Cliniques-1433, and INSERM U1116 & CHU Nancy, Institut Lorrain du Cœur et des Vaisseaux, Vandoeuvre lès Nancy, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Girerd
authors.affiliation: From the Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France; Université de Lyon, CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, France.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Courand
authors.affiliation: From the Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France; Université de Lyon, CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Lantelme
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging; D001018:Aortic Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D001027:Aortography / Q000379:methods; D006328:Cardiac Catheterization / Q000009:adverse effects; D002423:Cause of Death; D016009:Chi-Square Distribution; D000072226:Computed Tomography Angiography; D005260:Female; D005602:France; D006333:Heart Failure / Q000209:etiology; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D018579:Patient Selection; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality
keywords: Aorta; Aortic stenosis; Calcifications; Outcomes; Stiffness; TAVI