Aorta calcification burden: Towards an integrative predictor of cardiac outcome after transcatheter aortic valve implantation

• Published in: Atherosclerosis 2016-03, Vol.246, p.161-168
• Main Authors: Harbaoui, Brahim, Montoy, Mathieu, Charles, Paul, Boussel, Loic, Liebgott, Hervé, Girerd, Nicolas, Courand, Pierre-Yves, Lantelme, Pierre
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aorta; Aorta, Abdominal - diagnostic imaging; Aorta, Thoracic - diagnostic imaging; Aortic Diseases - complications; Aortic Diseases - diagnostic imaging; Aortic Diseases - mortality; Aortic stenosis; Aortic Valve Stenosis - complications; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - therapy; Aortography - methods; Bioengineering; Calcifications; Cardiac Catheterization - adverse effects; Cardiovascular; Cause of Death; Chi-Square Distribution; Computed Tomography Angiography; Female; France; Heart Failure - etiology; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - mortality; Humans; Imaging; Kaplan-Meier Estimate; Life Sciences; Male; Multidetector Computed Tomography; Multivariate Analysis; Outcomes; Patient Selection; Predictive Value of Tests; Proportional Hazards Models; Risk Assessment; Risk Factors; Severity of Illness Index; Stiffness; TAVI; Time Factors; Treatment Outcome; Vascular Calcification - complications; Vascular Calcification - diagnostic imaging; Vascular Calcification - mortality
• ISSN: 0021-9150; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2016.01.013

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.