Distribution of Aortic Root Calcium in Relation to Frame Expansion and Paravalvular Leakage After Transcatheter Aortic Valve Implantation (TAVI): An Observational Study Using a Patient-specific Contrast Attenuation Coefficient for Calcium Definition and Independent Core Lab Analysis of Paravalvular Leakage
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BACKGROUND: Calcium is a determinant of paravalvular leakage (PVL) after transcatheter aortic valve implantation (TAVI). This is based on a fixed contrast attenuation value while X-ray attenuation is patient-dependent and without considering frame expansion and PVL location. We examined the role of calcium in (site-specific) PVL after TAVI using a patient-specific contrast attenuation coefficient combined with frame expansion. METHODS: 57 patients were included with baseline CT, post-TAVI transthoracic echocardiography and rotational angiography (R-angio). Calcium load was assessed using a patient-specific contrast attenuation coefficient. Baseline CT and post-TAVI R-angio were fused to assess frame expansion. PVL was assessed by a core lab. RESULTS: Overall, the highest calcium load was at the non-coronary-cusp-region (NCR, 436 mm3) vs. the right-coronary-cusp-region (RCR, 233 mm3) and the left-coronary-cusp-region (LCR, 244 mm3), p < 0.001. Calcium load was higher in patients with vs. without PVL (1,137 vs. 742 mm3, p = 0.012) and was an independent predictor of PVL (odds ratio, 4.83, p = 0.004). PVL was seen most often in the LCR (39% vs. 21% [RCR] and 19% [NCR]). The degree of frame expansion was 71% at the NCR, 70% at the RCR and 74% at the LCR without difference between patients with or without PVL. CONCLUSIONS: Calcium load was higher in patients with PVL and was an independent predictor of PVL. While calcium was predominantly seen at the NCR, PVL was most often at the LCR. These findings indicate that in addition to calcium, specific anatomic features play a role in PVL after TAVI.
Abstract
BACKGROUND: Calcium is a determinant of paravalvular leakage (PVL) after transcatheter aortic valve implantation (TAVI). This is based on a fixed contrast attenuation value while X-ray attenuation is patient-dependent and without considering frame expansion and PVL location. We examined the role of calcium in (site-specific) PVL after TAVI using a patient-specific contrast attenuation coefficient combined with frame expansion. METHODS: 57 patients were included with baseline CT, post-TAVI transthoracic echocardiography and rotational angiography (R-angio). Calcium load was assessed using a patient-specific contrast attenuation coefficient. Baseline CT and post-TAVI R-angio were fused to assess frame expansion. PVL was assessed by a core lab. RESULTS: Overall, the highest calcium load was at the non-coronary-cusp-region (NCR, 436 mm3) vs. the right-coronary-cusp-region (RCR, 233 mm3) and the left-coronary-cusp-region (LCR, 244 mm3), p < 0.001. Calcium load was higher in patients with vs. without PVL (1,137 vs. 742 mm3, p = 0.012) and was an independent predictor of PVL (odds ratio, 4.83, p = 0.004). PVL was seen most often in the LCR (39% vs. 21% [RCR] and 19% [NCR]). The degree of frame expansion was 71% at the NCR, 70% at the RCR and 74% at the LCR without difference between patients with or without PVL. CONCLUSIONS: Calcium load was higher in patients with PVL and was an independent predictor of PVL. While calcium was predominantly seen at the NCR, PVL was most often at the LCR. These findings indicate that in addition to calcium, specific anatomic features play a role in PVL after TAVI.
참고문헌 (30)
- Smith CR, "Transcatheter versus surgical aortic-valve replacement in high-risk patients", N Engl J Med, 364, pp.2187~2198 (2011)
- Leon MB, "Transcatheter or surgical aortic-valve replacement in intermediate-risk patients", N Engl J Med, 374, pp.1609~1620 (2016)
- Reardon MJ, "Surgical or transcatheter aortic-valve replacement in intermediate-risk patients", N Engl J Med, 376, pp.1321~1331 (2017)
- Popma JJ, "Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients", N Engl J Med, 380, pp.1706~1715 (2019)
- Mack MJ, "Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients", N Engl J Med, 380, pp.1695~1705 (2019)
- Padang R, "Comparative survival and role of STS score in aortic paravalvular leak after SAVR or TAVR : a retrospective study from the USA", BMJ Open, 8, pp.e022437~ (2018)
- Abdel-Wahab M, "Comparison of balloon-expandable vs self-expandable valves in patients undergoing transcatheter aortic valve replacement : the CHOICE randomized clinical trial", JAMA, 311, pp.1503~1514 (2014)
- Rodríguez-Olivares R, "Differences in frame geometry between balloon-expandable and self-expanding transcatheter heart valves and association with aortic regurgitation", Rev Esp Cardiol(Engl Ed), 69, pp.392~400 (2016)
- Rodríguez-Olivares R, "Does frame geometry play a role in aortic regurgitation after Medtronic CoreValve implantation?", EuroIntervention, 12, pp.519~525 (2016)
- Di Martino LF, "Relation between calcium burden, echocardiographic stent frame eccentricity and paravalvular leakage after corevalve transcatheter aortic valve implantation", Eur Heart J Cardiovasc Imaging, 18, pp.648~653 (2017)
- Rahhab Z, "Determinants of aortic regurgitation after transcatheter aortic valve implantation. An observational study using multi-slice computed tomography-guided sizing", J Cardiovasc Surg(Torino), 58, pp.598~605 (2017)
- Abdelghani M, "Bioprosthetic valve performance after transcatheter aortic valve replacement with self-expanding versus balloon-expandable valves in large versus small aortic valve annuli : insights from the CHOICE trial and the CHOICE-Extend registry", JACC Cardiovasc Interv, 11, pp.2507~2518 (2018)
- Rodríguez-Olivares R, "Impact of device-host interaction on paravalvular aortic regurgitation with different transcatheter heart valves", Cardiovasc Revasc Med, 20, pp.126~132 (2019)
- Haensig M, "Aortic valve calcium scoring is a predictor of significant paravalvular aortic insufficiency in transapical-aortic valve implantation", Eur J Cardiothorac Surg, 41, pp.1234~1241 (2012)
- Achenbach S, "SCCT expert consensus document on computed tomography imaging before transcatheter aortic valve implantation(TAVI)", transcatheter aortic valve replacement(TAVR), 2012, pp.6, 366~380
- Ewe SH, "Location and severity of aortic valve calcium and implications for aortic regurgitation after transcatheter aortic valve implantation", Am J Cardiol, 108, pp.1470~1477 (2011)
- Schultz C, "The use of MSCT for the evaluation of the aortic root before transcutaneous aortic valve implantation : the Rotterdam approach", EuroIntervention, 6, pp.505~511 (2010)
- Hansson NC, "The impact of calcium volume and distribution in aortic root injury related to balloon-expandable transcatheter aortic valve replacement", J Cardiovasc Comput Tomogr, 9, pp.382~392 (2015)
- Rodríguez-Olivares R, "Determinants of image quality of rotational angiography for on-line assessment of frame geometry after transcatheter aortic valve implantation", Int J Cardiovasc Imaging, 32, pp.1021~1029 (2016)
- Schultz CJ, "Rotational angiography with motion compensation : first-in-man use for the 3D evaluation of transcatheter valve prostheses", EuroIntervention, 11, pp.442~449 (2015)
- Kappetein AP, "Updated standardized endpoint definitions for transcatheter aortic valve implantation : the Valve Academic Research Consortium-2 consensus document", J Am Coll Cardiol, 60, pp.1438~1454 (2012)
- Pibarot P, "Assessment of paravalvular regurgitation following TAVR : a proposal of unifying grading scheme", JACC Cardiovasc Imaging, 8, pp.340~360 (2015)
- McAlpine WA, "Heart and Coronary Arteries: An Anatomical Atlas for Clinical Diagnosis, Radiological Investigation, and Surgical Treatment", pp.163~178 (1975), Springer-Verlag
- Piazza N, "Anatomy of the aortic valvar complex and its implications for transcatheter implantation of the aortic valve", Circ Cardiovasc Interv, 1, pp.74~81 (2008)
- Muresian H, "The clinical anatomy of the mitral valve", Clin Anat, 22, pp.85~98 (2009)
- Parish LM, "The dynamic anterior mitral annulus", Ann Thorac Surg, 78, pp.1248~1255 (2004)
- Fujita B, "Calcium distribution patterns of the aortic valve as a risk factor for the need of permanent pacemaker implantation after transcatheter aortic valve implantation", Eur Heart J Cardiovasc Imaging, 17, pp.1385~1393 (2016)
- Desai MY, "Increased aorto-mitral curtain thickness independently predicts mortality in patients with radiation-associated cardiac disease undergoing cardiac surgery", Ann Thorac Surg, 97, pp.1348~1355 (2014)
- van der Boon RM, "New conduction abnormalities after TAVI--frequency and causes", Nat Rev Cardiol, 9, pp.454~463 (2012)
- Ruile P, "Fusion imaging of pre-and post-procedural computed tomography angiography in transcatheter aortic valve implantation patients : evaluation of prosthesis position and its influence on new conduction disturbances", Eur Heart J Cardiovasc Imaging, 20, pp.781~788 (2019)