Park, Jun-Bean; Hwang, In-Chang; Lee, Whal; Han, Jung-Kyu; Kim, Chi-Hoon; Lee, Seung-Pyo; Yang, Han-Mo; Park, Eun-Ah; Kim, Hyung-Kwan; Chiam, Paul T L; Kim, Yong-Jin; Koo, Bon-Kwon; Sohn, Dae-Won; Ahn, Hyuk; Kang, Joon-Won; Park, Seung-Jung; Kim, Hyo-Soo
International journal of cardiology
2018May ; 259 ( 5 ) :60-68.
PMID : 29472027
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Park, Jun-Bean - Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 03080, South Korea.
Hwang, In-Chang - Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 03080, South Korea.
Lee, Whal - Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 03080, South Korea. Electronic address whal.lee@gmail.com.
Han, Jung-Kyu - Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 03080, South Korea.
Kim, Chi-Hoon - Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 03080, South Korea.
Lee, Seung-Pyo - Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 03080, South Korea.
Yang, Han-Mo - Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 03080, South Korea.
Park, Eun-Ah - Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 03080, South Korea.
Kim, Hyung-Kwan - Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 03080, South Korea.
Chiam, Paul T L - Department of Cardiology, National Heart Centre Singapore, Mistri Wing, 5 Hospital Drive, 169609, Singapore.
Kim, Yong-Jin - Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 03080, South Korea.
Koo, Bon-Kwon - Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 03080, South Korea.
Sohn, Dae-Won - Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 03080, South Korea.
Ahn, Hyuk - Department of Cardiovascular Thoracic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 03080, South Korea.
Kang, Joon-Won - Department of Radiology, Asan Medical Center, 88 Olympic-ro, 43-Gil, Songpa-gu, Seoul 05505, South Korea.
Park, Seung-Jung - Division of Cardiology, Department of Internal Medicine, Asan Medical Center, 88 Olympic-ro, 43-Gil, Songpa-gu, Seoul, South Korea.
Kim, Hyo-Soo - Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 03080, South Korea. Electronic address hyosoo@snu.ac.kr.
ABSTRACT
BACKGROUND: Limited data exist regarding the impact of aortic valve calcification (AVC) eccentricity on the risk of paravalvular regurgitation (PVR) and response to balloon post-dilation (BPD) after transcatheter aortic valve replacement (TAVR). We investigated the prognostic value of AVC eccentricity in predicting the risk of PVR and response to BPD in patients undergoing TAVR.
METHODS: We analyzed 85 patients with severe aortic stenosis who underwent self-expandable TAVR (43 women; 77.2±7.1years). AVC was quantified as the total amount of calcification (total AVC load) and as the eccentricity of calcium (EoC) using calcium volume scoring with contrast computed tomography angiography (CTA). The EoC was defined as the maximum absolute difference in calcium volume scores between 2 adjacent sectors (bi-partition method) or between sectors based on leaflets (leaflet-based method).
RESULTS: Total AVC load and bi-partition EoC, but not leaflet-based EoC, were significant predictors for the occurrence of ?¥moderate PVR, and bi-partition EoC had a better predictive value than total AVC load (area under the curve [AUC]=0.863 versus 0.760, p for difference=0.006). In multivariate analysis, bi-partition EoC was an independent predictor for the risk of ?¥moderate PVR regardless of perimeter oversizing index. The greater bi-partition EoC was the only significant parameter to predict poor response to BPD (AUC=0.775, p=0.004). CONCLUSION: Pre-procedural assessment of AVC eccentricity using CTA as "bi-partition EoC" provides useful predictive information on the risk of significant PVR and response to BPD in patients undergoing TAVR with self-expandable valves. CI - Copyright ??2017 Elsevier B.V. All rights reserved.
keyword
*Aortic valve calcification; *Balloon post-dilation; *Computed tomography angiography; *Paravalvular regurgitation; *Transcatheter aortic valve replacement
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