scholarly journals Non-invasive quantitative characterization of aortic valve tissue composition from computed tomography angiography improves patient risk stratification in transcatheter aortic valve implantation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Grodecki ◽  
B.K Tamarappoo ◽  
Z Huczek ◽  
S Jedrzejczyk ◽  
S Cadet ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Low Flow ◽  
Tissue Composition ◽  
Tissue Volume ◽  
Valve Tissue ◽  
Cardiac Cta ◽  
Transcatheter Aortic Valve ◽  
Calcified Tissue ◽  
Valve Implantation ◽  
Total Tissue

Abstract Background Computed tomography angiography (CTA) performed for procedural planning of transcatheter aortic valve implantation (TAVI) can be used for a more complete characterization of aortic valve tissue beyond calcium assessment. Combining quantitative data on both noncalcified and calcified tissues may improve differentiation of aortic stenosis (AS) subtypes and prognostication post-TAVI. Purpose We sought to noninvasively assess aortic valve tissue composition with quantitative cardiac CTA in patients with AS and its prognostic vaalue in those who underwent TAVI. Methods In 185 consecutive AS patients in a prospective registry who underwent cardiac CTA before TAVR and 90 matched controls with normal aortic valves, non-luminal aortic valve tissue were identified using semi-automated software as non-calcified (low-attenuation [−30 to 30 Hounsfield Units (HU)], fibro-fatty (31 to 130 HU), fibrous (131 to 350 HU) and calcified (>650 HU) tissue; with total tissue as (non-calcified + calcified components). Volumes of each component and composition [(tissue component volume/total tissue volume) ×100%] were quantified. The association of aortic valve composition and clinical outcomes post-TAVI including all-cause mortality was evaluated using Valve Academic Research Consortium (VARC)-2 definitions. Results AS patients had greater aortic valve tissue volume (median 2000.2, vs 527.8 mm3, p<0.001) with a higher calcified tissue composition (41.8% vs 3.4%, p<0.001) compared to controls. Total aortic valve tissue (noncalcified and calcified) volume yielded the highest area under the operating curve (AUC) for diagnosing severe AS (0.93,95% CI:0.93–0.99) as compared to calcified tissue volume alone (0.87,95% CI:0.81–0.94, p=0.002). Low-flow low-gradient AS was associated with increase in total tissue volume compared to controls (1515.3 vs 527.8 mm3, p<0.001), with lower volumes of calcified tissue than high-gradient AS (412.5 vs 829.6 mm3, p<0.001). Device success was achieved in 88% (164 of 185) patients and prevalence of moderate or severe paravalvular leak was 3.8%, however no differences between in aortic valve composition were observed in patients with and without device success. Early safety endpoints occurred in 16.1% (29 of 180) patients and 30-day all-cause mortality was 4.4%. Whereas only calcified tissue volume was related to VARC-2 early safety, AUC for prediction of 30-day mortality post-TAVI was 0.793 (95% CI:0.685–0.901) for total tissue volume and 0.776 (95% CI:0.676–0.876) for calcified tissue volume. Conclusions Quantitative CTA assessment of aortic valve tissue volume and composition can improve identification of high-gradient AS and low-flow low-gradient AS patients referred for TAVI and predict 30-day mortality post-TAVI. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Heart, Lung, and Blood Institute (NHLBI)

scholarly journals Non-calcific aortic tissue quantified from computed tomography angiography improves diagnosis and prognostication of patients referred for transcatheter aortic valve implantation

2020 ◽  
Author(s):  
Kajetan Grodecki ◽  
Balaji K Tamarappoo ◽  
Zenon Huczek ◽  
Szymon Jedrzejczyk ◽  
Sebastien Cadet ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Aortic Valve ◽  
Computed Tomography Angiography ◽  
Aortic Tissue ◽  
Tissue Component ◽  
Tissue Volume ◽  
Valve Tissue ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Aims We aimed to investigate the role of aortic valve tissue composition from quantitative cardiac computed tomography angiography (CTA) in patients with severe aortic stenosis (AS) for the differentiation of disease subtypes and prognostication after transcatheter aortic valve implantation (TAVI). Methods and results Our study included 447 consecutive AS patients from six high-volume centres reporting to a prospective nationwide registry of TAVI procedures (POL-TAVI), who underwent cardiac CTA before TAVI, and 224 matched controls with normal aortic valves. Components of aortic valve tissue were identified using semi-automated software as calcific and non-calcific. Volumes of each tissue component and composition [(tissue component volume/total tissue volume) × 100%] were quantified. Relationship of aortic valve composition with clinical outcomes post-TAVI was evaluated using Valve Academic Research Consortium (VARC)-2 definitions. High-gradient (HG) AS patients had significantly higher aortic tissue volume compared to low-flow low-gradient (LFLG)-AS (1672.7 vs. 1395.3 mm3, P < 0.001) as well as controls (509.9 mm3, P < 0.001), but increased non-calcific tissue was observed in LFLG compared to HG patients (1063.6 vs. 860.2 mm3, P < 0.001). Predictive value of aortic valve calcium score [area under the curve (AUC) 0.989, 95% confidence interval (CI): 0.981–0.996] for severe AS was improved after addition of non-calcific tissue volume (AUC 0.995, 95% CI: 0.991–0.999, P = 0.011). In the multivariable analysis of clinical and quantitative computed tomography parameters of aortic valve tissue, non-calcific tissue volume [odds ratio (OR) 5.2, 95% CI 1.8–15.4, P = 0.003] and history of stroke (OR 2.6, 95% CI 1.1–6.5, P = 0.037) were independent predictors of 30-day major adverse cardiovascular event (MACE). Conclusion Quantitative CTA assessment of aortic valve tissue volume and composition can improve detection of severe AS, differentiation between HG and LFLG-AS in patients referred for TAVI as well as prediction of 30-day MACEs post-TAVI, over the current clinical standard.

scholarly journals How to deal with low-flow low-gradient aortic stenosis and reduced left ventricle ejection fraction: from literature review to tips for clinical practice

2021 ◽  
Author(s):  
F. Contorni ◽  
M. Fineschi ◽  
A. Iadanza ◽  
A. Santoro ◽  
G. E. Mandoli ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Left Ventricle ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Left Ventricle Ejection Fraction ◽  
Low Flow ◽  
Diagnostic Tools ◽  
Transcatheter Aortic Valve ◽  
Valve Implantation

AbstractLow-flow low-gradient aortic stenosis (LFLG AS) with reduced left ventricle ejection fraction (LVEF) is still a diagnostic and therapeutic challenge. The aim of this paper is to review the latest evidences about the assessment of the valvular disease, usually difficult because of the low-flow status, and the therapeutic options. Special emphasis is given to the available diagnostic tools for the characterization of LFLG AS without functional reserve at stress echocardiography and to the factors that clinicians should evaluate to choose between surgical aortic valve repair, transcatheter aortic valve implantation, or medical therapy.

scholarly journals The clinical significance of the incorporation of tissue Doppler imaging into low-dose Dobutamine stress echocardiography in patients with aortic stenosis prior to Transcatheter aortic valve implantation

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sahrai Saeed ◽  
Joerg Kellermair ◽  
Jon Herstad ◽  
Øyvind Bleie
Keyword(s):  
Aortic Valve ◽  
Low Dose ◽  
Contractile Function ◽  
Tissue Doppler ◽  
Dobutamine Stress ◽  
Doppler Imaging ◽  
Low Flow ◽  
Transcatheter Aortic Valve ◽  
Mean Pressure ◽  
Valve Implantation

Abstract Background Low-dose dobutamine stress echocardiography (DSE) is indicated in patients with low flow (stroke volume index [SVi] < 35 ml/m2) low gradient (mean pressure gradient < 40 mmHg) and left ventricular ejection fraction (LVEF) < 50% aortic stenosis (AS) to assess LV contractile reserve (> 20% increase in SVi) and severity grade of AS. Severe AS is defined by a mean pressure gradient of 40 mmHg occurring at any time during the test when aortic valve area remains < 1.0 cm2. Case presentation This case report highlights the utility of mitral annular systolic velocity (S′) by tissue Doppler imaging and peak LV outflow tract (LVOT) velocity as markers of LV intrinsic contractile function during DSE in a patient with low flow low gradient AS and reduced EF prior to transcatheter aortic valve implantation (TAVI). Conclusions Mitral annular S′ and peak LVOT velocities are reliable markers of LV intrinsic contractile function and should be incorporated into routine low-dose DSE.

Sign in / Sign up

Export Citation Format

Share Document