Non-calcific aortic tissue volume quantified from computed tomography angiography was an independent predictor of 30-day major adverse cardiovascular events following TAVI (OR 5.2).
Observational (n=671)
Yes
Does quantitative CTA assessment of non-calcific aortic valve tissue improve the diagnosis of severe AS and prediction of 30-day MACE in patients referred for TAVI?
Effect estimate: OR 5.2 (95% CI 1.8-15.4)
p-value: p=0.003
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.
Grodecki et al. (Fri,) conducted a observational in Severe aortic stenosis referred for TAVI (n=671). Non-calcific aortic tissue volume quantified from CTA was evaluated on 30-day major adverse cardiovascular event (MACE) (OR 5.2, 95% CI 1.8-15.4, p=0.003). Non-calcific aortic tissue volume quantified from computed tomography angiography was an independent predictor of 30-day major adverse cardiovascular events following TAVI (OR 5.2).