RESUMEN
BACKGROUND: Aortic valve calcification patterns were associated with short- and long-term outcomes in previous small observational datasets of patients undergoing transcatheter aortic valve implantation (TAVI). The specific impact of multi detector-row computed tomography (MDCT) findings on outcomes in women has not been reported. We sought to describe the associations between MDCT characteristics and clinical outcomes in a registry of 547 women undergoing TAVI. METHODS: WIN-TAVI is the first all-female registry to study the safety and effectiveness of TAVI in women (nâ¯=â¯1019). Thirteen sites participated in the MDCT sub-study and contributed pre-TAVI MDCT studies in 547 consecutive subjects. All MDCT data were analyzed in an independent core lab blinded to clinical outcomes. Key measurements included number of valve leaflets, aortic annulus area and perimeter, left and right coronary artery height, aortic cusp calcium volume, commissural calcification and left ventricular outflow tract (LVOT) calcification. Calcium volume of the aortic valvular complex was quantified using a threshold relative to patient-specific contrast attenuation in the arterial blood pool. We examined univariate and multivariate associations between ECG-gated contrast MDCT characteristics and 1-year mortality or stroke, new pacemaker implantation and new onset atrial fibrillation (AF). RESULTS: The CT sub-study sample had a mean age of 82.8⯱â¯6.3 years, mean logistic EuroSCORE of 17.8⯱â¯11.3%, and mean STS score of 8.2⯱â¯7.4%. Transfemoral access was used in 89.6% of patients. After multivariate adjustment, moderate or severe LVOT calcification was an independent predictor of 1-year mortality or stroke (HRâ¯=â¯1.91; 95% CI: 1.11-3.30; pâ¯=â¯0.02). Calcium volume in the right coronary cusp was an independent predictor of new pacemaker (HRâ¯=â¯1.18 per 100â¯m3 increment; pâ¯=â¯0.04), whereas calcium volume of the non-coronary cusp had a protective effect (HRâ¯=â¯0.78 per 100â¯mm3 increment; pâ¯=â¯0.004). Severe calcification of the non-coronary/right-coronary commissure was an independent predictor of new AF (HRâ¯=â¯5.1; pâ¯=â¯0.008). CONCLUSION: Computed tomography provides important prognostic information in women undergoing TAVI. Moderate or severe LVOT calcification is associated to an almost two-fold increased risk of mortality or stroke at one year. Different calcification patterns of the aortic valve may predict diverse rhythm abnormalities.
Asunto(s)
Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/cirugía , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/patología , Válvula Aórtica/trasplante , Arritmias Cardíacas/epidemiología , Calcinosis/diagnóstico por imagen , Calcinosis/cirugía , Tomografía Computarizada Multidetector , Accidente Cerebrovascular/epidemiología , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Salud de la Mujer , Anciano , Anciano de 80 o más Años , Válvula Aórtica/fisiopatología , Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/mortalidad , Estenosis de la Válvula Aórtica/fisiopatología , Arritmias Cardíacas/mortalidad , Arritmias Cardíacas/terapia , Calcinosis/mortalidad , Calcinosis/fisiopatología , Estimulación Cardíaca Artificial , Europa (Continente)/epidemiología , Femenino , Humanos , Incidencia , Estimación de Kaplan-Meier , Modelos Logísticos , Análisis Multivariante , América del Norte/epidemiología , Valor Predictivo de las Pruebas , Modelos de Riesgos Proporcionales , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Accidente Cerebrovascular/mortalidad , Factores de Tiempo , Reemplazo de la Válvula Aórtica Transcatéter/mortalidad , Resultado del Tratamiento , Obstrucción del Flujo Ventricular Externo/diagnóstico por imagen , Obstrucción del Flujo Ventricular Externo/mortalidad , Obstrucción del Flujo Ventricular Externo/fisiopatologíaRESUMEN
AIMS: To evaluate the feasibility of procedural planning for transcatheter aortic valve implantation (TAVI) using rotational angiography (R-angio) by comparison with multislice computed tomography (MSCT) and to investigate determinants of the image quality of R-angio. METHODS AND RESULTS: Patients who underwent R-angio of the left ventricle and cardiac MSCT were eligible. R-angio acquisition was performed during contrast injection through a 6F pigtail catheter positioned in the left ventricle. On 3D R-angio and MSCT data sets, diameter measurements were made on short-axis images at the level of the aortic annulus (D(perimeter), D(area)), ascending aorta, sino-tubular junction (ST-junction), and the sinus of Valsalva. At the level of the aortic annulus, diagnostic image quality was obtained in 49 of 56 patients. In all patients with a body mass index (BMI) < 29 kg/m(2), image quality was acceptable whether or not rapid pacing was used. In patients with BMI ≥ 29 kg/m(2), the image quality was poor in 1 of 9 (11%) who were rapidly paced compared with 6 of 12 (50%) who were not. The correlation between R-angio and MSCT measurements was high for aortic annulus D(perimeter), D(area), ST-junction, Valsalva sinus, and ascending aorta (respectively, R = 0.90, 0.90, 0.91, 0.92, and 0.89). The correlations improved further when the analysis was limited to patients with a BMI < 29 kg/m(2) (respectively, 0.92, 0.92, 0.92, 0.92, and 0.93). CONCLUSION: R-angio of the left ventricle allows precise measurement of the aortic root and annulus and was feasible for sizing at the time of TAVI. Diagnostic image quality was obtained without rapid pacing in all patients with a BMI < 29 kg/m(2).