ASSOCIATION OF AORTIC BIOPROSTHETIC CALCIFICATION MEASURED BY CT WITH HEMODYNAMIC AND CLINICAL OUTCOMES
CCC ePoster Library. Clavel M. 10/26/19; 280312; 254
Marie-Annick Clavel
Marie-Annick Clavel
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Abstract
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BACKGROUND: The prognostic value of aortic valve calcification (AVC) measured by non-contrast multidetector computed tomography (MDCT) has been well validated in native aortic valve stenosis (AS) and a sex-specific cut-off value of AVC have been proposed to identify severe AS. There are however few data on the impact of MDCT quantitation of valve leaflet calcification following biological aortic valve replacement (AVR). The study aimed to analyze the association of bioprosthetic AVC with: i) valve hemodynamic deterioration measured by echocardiography and ii) clinical outcomes and to determine whether there is any sex-related difference in these associations.

METHODS AND RESULTS: Methods: From 2008 to 2010, we prospectively enrolled 204 patients who had undergone AVR at an average of 7.6 ± 3.4 years ago. We performed echocardiography and MDCT at 2 visits separated by 3 years. AVC measured by agastaton method was indexed to the cross-sectional area of aortic annulus to calculate the AVC density (AVCd). Correlation between the hemodynamic valve deterioration evaluated by echocardiographic and AVCd from postoperative to recruitment was assessed. The primary endpoint was mortality or reintervention. Results: The cohort consisted of 142 (70%) men and 62 (30%) women. Women were older (69.4 ± 7.4 years vs. 66.4 ± 8.0 years, p=0.013) with higher postoperative mean gradient (13.2 ± 5.7 mmHg vs. 11.2 ± 5.0 mmHg, p=0.015) and more severe patient-prosthesis mismatch (25.8% vs. 9.9%, p=0.009). Accordingly, AVCd at baseline visit were significantly higher in women (14.2 AU/cm2 [IQR: 2.4 to 59.5 AU/cm2] vs. 7.5 AU/cm2 [IQR: 0 to 24.5 AU/cm2], p=0.035). AVCd correlated with mean gradient change both in men (r=0.37, p < 0.001) and in women (r=0.48, p < 0.001) (Figure). After adjusting for clinical factors, the correlation remained significant (p < 0.001). During a median follow-up of 5.7 [3.9, 8.0] years, there were 134 (65.7%) death or reintervention. Univariate analysis showed a strong association between AVCd and the composite endpoint (p < 0.001) with a linear pattern by spline curve (Figure). On multivariable analysis, AVCd independently predicted the composite endpoint (adjusted HR: 1.11; 95% CI: 1.06 to 1.2, p < 0.001) (Figure). The inclusion of AVCd in the model improved the prediction of the event with an integrated discrimination index (IDI) of 0.056 (p=0.032).

CONCLUSION: Bioprosthesis calcification, as measured by MDCT shows no sex-related pattern as opposed to calcification of the native valves. AVCd provides independent and incremental prognostic value beyond clinical and echocardiographic assessment.
BACKGROUND: The prognostic value of aortic valve calcification (AVC) measured by non-contrast multidetector computed tomography (MDCT) has been well validated in native aortic valve stenosis (AS) and a sex-specific cut-off value of AVC have been proposed to identify severe AS. There are however few data on the impact of MDCT quantitation of valve leaflet calcification following biological aortic valve replacement (AVR). The study aimed to analyze the association of bioprosthetic AVC with: i) valve hemodynamic deterioration measured by echocardiography and ii) clinical outcomes and to determine whether there is any sex-related difference in these associations.

METHODS AND RESULTS: Methods: From 2008 to 2010, we prospectively enrolled 204 patients who had undergone AVR at an average of 7.6 ± 3.4 years ago. We performed echocardiography and MDCT at 2 visits separated by 3 years. AVC measured by agastaton method was indexed to the cross-sectional area of aortic annulus to calculate the AVC density (AVCd). Correlation between the hemodynamic valve deterioration evaluated by echocardiographic and AVCd from postoperative to recruitment was assessed. The primary endpoint was mortality or reintervention. Results: The cohort consisted of 142 (70%) men and 62 (30%) women. Women were older (69.4 ± 7.4 years vs. 66.4 ± 8.0 years, p=0.013) with higher postoperative mean gradient (13.2 ± 5.7 mmHg vs. 11.2 ± 5.0 mmHg, p=0.015) and more severe patient-prosthesis mismatch (25.8% vs. 9.9%, p=0.009). Accordingly, AVCd at baseline visit were significantly higher in women (14.2 AU/cm2 [IQR: 2.4 to 59.5 AU/cm2] vs. 7.5 AU/cm2 [IQR: 0 to 24.5 AU/cm2], p=0.035). AVCd correlated with mean gradient change both in men (r=0.37, p < 0.001) and in women (r=0.48, p < 0.001) (Figure). After adjusting for clinical factors, the correlation remained significant (p < 0.001). During a median follow-up of 5.7 [3.9, 8.0] years, there were 134 (65.7%) death or reintervention. Univariate analysis showed a strong association between AVCd and the composite endpoint (p < 0.001) with a linear pattern by spline curve (Figure). On multivariable analysis, AVCd independently predicted the composite endpoint (adjusted HR: 1.11; 95% CI: 1.06 to 1.2, p < 0.001) (Figure). The inclusion of AVCd in the model improved the prediction of the event with an integrated discrimination index (IDI) of 0.056 (p=0.032).

CONCLUSION: Bioprosthesis calcification, as measured by MDCT shows no sex-related pattern as opposed to calcification of the native valves. AVCd provides independent and incremental prognostic value beyond clinical and echocardiographic assessment.
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