scholarly journals Factors associated with a high or low implantation of self-expanding devices in TAVR

2021 ◽  
Author(s):  
Verena Veulemans ◽  
Oliver Maier ◽  
Kerstin Piayda ◽  
Kira Lisanne Berning ◽  
Stephan Binnebößel ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Aortic Valve ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Ventricular Pacing ◽  
Aortic Valve Calcification ◽  
Valve Calcification ◽  
Implantation Depth ◽  
Rapid Ventricular Pacing ◽  
The Impact

Abstract Objectives Optimizing valve implantation depth (ID) plays a crucial role in minimizing conduction disturbances and achieving optimal functional integrity. Until now, the impact of intraprocedural fast (FP) or rapid ventricular pacing (RP) on the implantation depth has not been investigated. Therefore, we aimed to (1) evaluate the impact of different pacing maneuvers on ID, and (2) identify the independent predictors of deep ID. Methods 473 TAVR patients with newer-generation self-expanding devices were retrospectively enrolled and one-to-one propensity-score-matching was performed, resulting in a matching of 189 FP and RP patients in each cohort. The final ID was analyzed, and the underlying functional, anatomical, and procedural conditions were evaluated by univariate and multivariate analysis. Results The highest ID was reached under RP in severe aortic valve calcification and valve size 26 mm. Multivariate analysis identified left ventricular outflow (LVOT) calcification [OR 0.50 (0.31–0.81) p = 0.005*], a “flare” aortic root [OR 0.42 (0.25–0.71), p = 0.001*], and RP (OR 0.49 [0.30–0.79], p = 0.004*) as independent highly preventable predictors of a deep ID. In a model of protective factors, ID was significantly reduced with the number of protective criteria (0–2 criteria: − 5.7 mm ± 2.6 vs. 3–4 criteria − 4.3 mm ± 2.0; p < 0.0001*). Conclusion Data from this retrospective analysis indicate that RP is an independent predictor to reach a higher implantation depth using self-expanding devices. Randomized studies should prove for validation compared to fast and non-pacing maneuvers during valve delivery and their impact on implantation depth. Trail registration Clinical Trial registration: NCT01805739. Graphic abstract Study design: Evaluation of the impact of different pacing maneuvers (fast ventricular pacing—FP vs. rapid ventricular pacing—RP) on implantation depth (ID). After one-to-one-propensity-score-matching, independent protective and risk factors for a very deep ID beneath 6 mm toward the LVOT (< − 6 mm) were identified. Stent frame pictures as a courtesy by Medtronic®. AVC aortic valve calcification.

Impact of pericoronary inflammation assessed by coronary computed tomography angiography on the progression of aortic valve calcification

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Misawa ◽  
T Sugiyama ◽  
Y Kanaji ◽  
M Hoshino ◽  
M Yamaguchi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Aortic Valve ◽  
Computed Tomography Angiography ◽  
Coronary Computed Tomography Angiography ◽  
Aortic Valve Calcification ◽  
Valve Calcification ◽  
Coronary Computed Tomography ◽  
The Mean ◽  
The Impact

Abstract Background Aortic valve calcification (AVC) has been known as an independent predictor for adverse cardiovascular events and all-cause mortality. Previous studies demonstrated that AVC was associated with aortic valve inflammation and atherosclerosis. However, the relationship between the progression of AVC and pericoronary inflammation remains undetermined. Purpose The purpose of this study was to evaluate the impact of the pericoronary inflammation on the progression of AVC. Methods A total of 107 patients with suspected or known chronic coronary syndromes who underwent clinically indicated serial 320-slice coronary computed tomography angiography (CTA) at Tsuchiura Kyodo General Hospital from January 2011 to June 2019 were retrospectively studied. Pericoronary inflammation was assessed by pericoronary adipose tissue attenuation (PCATA) defined as the mean CT attenuation value of PCATA (−190 to −30 Hounsfield units [HU]) on proximal 40 mm segments of coronary arteries. AVC was quantified by Agatston score on CTA. The mean aortic attenuation (HU Aorta) and the standard deviation (SD) in the region of interest at the level of the sinotubular junction was measured. AVC was defined as the threshold for calcium detection (mean HU Aorta + 2SD). AVC index was calculated as follows: (follow-up/baseline) AVC divided by follow-up period. AVC progression was defined as newly-developed AVC at follow-up or an increased AVC index during follow-up. All patients were divided into two groups according to the presence or absence of AVC progression, and clinical characteristics and CT findings were compared between these two groups. Results AVC progression was observed in 26 patients (24.3%) between 2 serial CT examinations (median, 34 months). There was no significant difference in age, gender and the prevalence of other cardiovascular risk factors between the 2 groups. Patients in AVC progression group were associated with higher prevalence of elevated PCATA-LAD, higher LV mass index at baseline and the initial AVC presence. Receiver-operating characteristic curve analysis revealed that the optimal cut off value of PCATA-LAD for predicting AVC progression was −68.26 HU (area under the curve 0.605; 95% confidence interval [CI], 0.465–0.745). Multivariable logistic regression analysis revealed that baseline PCATA-LAD ≥−68.26 HU (odds ratio [OR], 3.12; 95% CI, 1.04–9.35, p=0.042) and the presence of baseline positive AVC (OR, 6.84; 95% CI, 2.34–20.0, p=0.0004) were independent predictors of AVC progression. Conclusions The increased pericoronary inflammation and the presence of AVC may help identify patients with high risk for future AVC progression. Funding Acknowledgement Type of funding source: None

Aortic valve calcium score for paravalvular aortic insufficiency (AVCS II) study in transapical aortic valve implantation

2016 ◽  
Vol 19 (1) ◽  
pp. 036 ◽  
Author(s):  
Martin Haensig ◽  
Lukas Lehmkuhl ◽  
Axel Linke ◽  
Philipp Kiefer ◽  
Chirojit Mukherjee ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Contrast Material ◽  
Calcium Score ◽  
Aortic Insufficiency ◽  
Aortic Valve Calcification ◽  
Valve Calcification ◽  
Contrast Enhanced ◽  
Aortic Valve Implantation ◽  
Valve Implantation ◽  
The Impact

<strong>Background:</strong> Transapical aortic valve implantation (TAAVI) has evolved into a routine procedure for select high-risk patients. The aim was to study the impact of native aortic valve calcification on paravalvular leaks in cardiac contrast-enhanced computed tomography (CT).<br /><strong>Methods:</strong> The degree and distribution of valve calcification were quantified using an Aortic Valve Calcium Score (AVCS) for each cusp separately (3mensio Valves). To reduce an artificial increase of the AVCS due to the presence of contrast material, we used thresholds for density [mean aortic density + 2*SD] and volume [0, 3, 5, 25, and 50 mm3] of calcification.<br /><strong>Results:</strong> 111 consecutive patients prior to TAAVI with preoperative CT aged 79.8 ± 5.8 years were included using the Edwards Sapien prosthesis. Paravalvular leaks were significantly associated with eccentric calcified plaques (r [Spearman] = 0.37; χ2-statistic = 15.4; P = .002), presence of LVOT calcium (r [Spearman] = 0.28; χ2-statistic = 11.3; P = .009), and the commissural gap at the anatomic ventriculo-arterial junction (r [Spearman] = 0.41-0.63; χ2-statistic = 50.8-53.0; <br />P = .002-≤.001). There was no significant association between the total AVCS and PV leaks (r [Spearman] = 0.076; χ2-statistic = 1.471; P = .240, 120 kV, 850 hounsfield units) with no additional use of a volume-based threshold.<br /><strong>Conclusion:</strong> Asymmetry of leaflet calcium distribution, LVOT calcium, and the commissural gap between leaflets were significantly associated with paravalvular leaks. Moreover, quantification of aortic valve calcification in contrast enhanced CTs shows only a weak correlation with paravalvular leakage and is therefore not reliable as a predictor, respectively.

scholarly journals Aortic Valve Calcification is Associated with Future Cognitive Impairment

2021 ◽  
pp. 1-7
Author(s):  
Hojune E. Chung ◽  
Jessica Chen ◽  
Dhairyasheel Ghosalkar ◽  
Jared L. Christensen ◽  
Alice J. Chu ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Aortic Valve ◽  
Lung Cancer Screening ◽  
Continuous Variable ◽  
Smoking History ◽  
Event Analysis ◽  
Aortic Valve Calcification ◽  
Valve Calcification ◽  
Ckd Stage ◽  
New Diagnosis

Background: While an association between atherosclerosis and dementia has been identified, few studies have assessed the longitudinal relationship between aortic valve calcification (AVC) and cognitive impairment (CI). Objective: We sought to determine whether AVC derived from lung cancer screening CT (LCSCT) was associated with CI in a moderate-to-high atherosclerotic risk cohort. Methods: This was a single site, retrospective analysis of 1401 U.S. veterans (65 years [IQI: 61, 68] years; 97%male) who underwent quantification of AVC from LCSCT indicated for smoking history. The primary outcome was new diagnosis of CI identified by objective testing (Mini-Mental Status Exam or Montreal Cognitive Assessment) or by ICD coding. Time-to-event analysis was carried out using AVC as a continuous variable. Results: Over 5 years, 110 patients (8%) were diagnosed with CI. AVC was associated with new diagnosis of CI using 3 Models for adjustment: 1) age (HR: 1.104; CI: 1.023–1.191; p = 0.011); 2) Model 1 plus hypertension, hyperlipidemia, diabetes, CKD stage 3 or higher (glomerular filtration rate <  60 mL/min) and CAD (HR: 1.097; CI: 1.014–1.186; p = 0.020); and 3) Model 2 plus CVA (HR: 1.094; CI: 1.011–1.182; p = 0.024). Sensitivity analysis demonstrated that the association between AVC and new diagnosis of CI remained significant upon exclusion of severe AVC (HR: 1.100 [1.013–1.194]; p = 0.023). Subgroup analysis demonstrated that this association remained significant when including education in the multivariate analysis (HR: 1.127 [1.030–1.233]; p = 0.009). Conclusion: This is the first study demonstrating that among mostly male individuals who underwent LCSCT, quantified aortic valve calcification is associated with new diagnosis of CI.

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