Association of Thoracic Aorta Calcium Score With Left Ventricular Hypertrophy and Clinical Outcomes in Patients With Severe Aortic Stenosis After Aortic Valve Replacement.

Cho, In-Jeong; Chang, Hyuk-Jae; Heo, Ran; Kim, In-Cheol; Sung, Ji Min; Chang, Byung-Chul; Shim, Chi Young; Hong, Geu-Ru; Chung, Namsik
The Annals of thoracic surgery
2017Jan ; 103 ( 1 ) :74-81.
저자 상세정보
Cho, In-Jeong -
Chang, Hyuk-Jae -
Heo, Ran -
Kim, In-Cheol -
Sung, Ji Min -
Chang, Byung-Chul -
Shim, Chi Young -
Hong, Geu-Ru -
Chung, Namsik -
BACKGROUND: Substantial aortic calcification is known to be associated with aortic stiffening and subsequent left ventricular (LV) hypertrophy. This study examined whether the thoracic aorta calcium score (TACS) is related to LV hypertrophy and whether it leads to an adverse prognosis in patients with severe aortic stenosis (AS) after aortic valve replacement (AVR).

METHODS: We retrospectively reviewed 47 patients (mean age, 64 짹 11 years) with isolated severe AS who underwent noncontrast computed tomography of the entire thoracic aorta and who received AVR. TACS was quantified using the volume method with values becoming log transformed ((log)[TACS+1]). Transthoracic echocardiography was performed before and 1 year after the operation.

RESULTS: Preoperative LV mass index (LVMI) displayed significant positive correlations with male gender (r?=?0.430, p?= 0.010) and (log)(TACS+1) (r?= 0.556, p?=?0.003). In multivariate linear regression analysis, only (log)(TACS+1) was independently associated with LVMI, even after adjusting for age, gender, transaortic mean pressure gradient, and coronary or valve calcium score. Independent determinants for postoperative LVMI included (log)(TACS+1) and preoperative LVMI after 1 year of follow-up echocardiography, adjusting for age, gender, indexed effective orifice area, and coronary or valve calcium score. During a median follow-up period of 54 months after AVR, there were 10 events (21%), which included 4 deaths from all-causes, 3 strokes, 2 inpatient admissions for heart failure, and 1 myocardial infarction. The event-free survival rate was significantly lower for patients with TACS of 2,257 mm(3) or higher compared with those whose TACS was lower than 2,257 mm(3) (log-rank p < 0.001).

CONCLUSIONS: High TACS was associated with increased LVMI among patients with severe AS. Further, high TACS usefully predicted less regression of LVMI and poor clinical outcomes after AVR. TACS may serve as a useful proxy for predicting LV remodeling and?adverse prognosis in patients with severe AS undergoing AVR. CI - Copyright ??2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Aorta, Thoracic/*diagnostic imaging/metabolism, Aortic Diseases/*complications/diagnosis, Aortic Valve Stenosis/*diagnosis/etiology/surgery, Calcinosis/complications/*diagnosis/metabolism, Calcium/metabolism, Echocardiography, Female, Follow-Up Studies, Heart Valve Prosthesis Implantation/*adverse effects, Humans, Hypertrophy, Left Ventricular/*complications/diagnosis/physiopathology, Male, Middle Aged, *Postoperative Complications, Prognosis, Retrospective Studies, Severity of Illness Index, Time Factors, Tomography, X-Ray Computed

주제명(Target field)
연구참여(Sample size)
질병특성(Condition Category)
연구설계(Study Design)
중재방법(Intervention Type)
중재명칭(Intervention Name)
High TACS was associated with increased LVMI among patients with severe AS; This is the first study to demonstrate an association between TACS and LVH among patients with severe AS after AVR. This study supports the contention that AS is not merely an isolated aortic valve disease but rather a complex disease related to the LV, the valve, and the arterial system.
연구비지원(Fund Source)
근거수준평가(Evidence Hierarchy)
ICD 03