Key result
Low aortic valve calcium scores during AVR link to ~60% higher mortality versus high scores.
Why the study?
Some patients have severe aortic valve stenosis despite a lower degree of aortic valve calcification, but their clinical features and prognosis after aortic valve replacement compared with higher calcification scores were unclear.
Does a low aortic valve calcification score predict higher mortality compared to a high score in patients undergoing aortic valve replacement for severe degenerative aortic stenosis?
Cohort (n=1,002)
Does a low aortic valve calcification score predict higher mortality compared to a high score in patients undergoing aortic valve replacement for severe degenerative aortic stenosis?
Effect estimate: adjusted HR 1.60 (95% CI 1.02 to 2.52)
p-value: p=0.04
In patients undergoing aortic valve replacement for severe degenerative aortic stenosis, a low aortic valve calcium score is associated with a higher risk of long-term all-cause mortality compared to a high calcium score.
Low AVC signals higher post-AVR mortality risk; leaves open whether scores should guide decisions or prompt prospective trials.
BACKGROUND: Some patients have severe aortic valve stenosis (AS) despite a lower degree of aortic valve calcification (AVC). This study compared the clinical features and prognosis of patients undergoing aortic valve replacement (AVR) for severe AS with a low AVC score compared with those with higher AVC scores. METHODS: This study included 1002 Korean patients with symptomatic severe degenerative AS who underwent AVR. We measured AVC score before AVR and defined low AVC as AVC score of <2000 units for male patients and <1300 units for female patients. Patients with bicuspid or rheumatic aortic valve disease were excluded. RESULTS: The mean age was 75.6±7.9 years and 487 patients (48.6%) were female. Mean left ventricular ejection fraction was 59.4%±10.4%, and concomitant coronary revascularisation was performed in 96 patients (9.6%). The median aortic valve calcium score was 3122 units (IQR 2249-4289 units) among male patients and 1756 units (IQR 1192-2572) among female patients. A total of 242 patients (24.2%) had low AVC; they were significantly younger (73.5±8.7 years vs 76.3±7.5 years, p<0.001) and were more likely to be female (59.5% vs 45.1%, p<0.001) and on haemodialysis (5.4% vs 1.8%, p=0.006) than those with high AVC. During a follow-up (median: 3.8 years), the patients with low AVC had significantly higher risk of death from any cause (adjusted HR 1.60, 95% CI 1.02 to 2.52, p=0.04), mostly non-cardiac cause. CONCLUSIONS: Patients with low AVC exhibit distinct clinical characteristics and a higher risk of long-term mortality compared with those with high AVC.
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Choi et al. (2023) conducted a cohort in symptomatic severe degenerative aortic valve stenosis (n=1,002). Low aortic valve calcium (AVC) score vs. High AVC score was evaluated on death from any cause (adjusted HR 1.60, 95% CI 1.02 to 2.52, p=0.04). Low aortic valve calcium scores in patients undergoing AVR for severe stenosis were associated with higher all-cause mortality than high scores (adjusted HR 1.60; 95% CI 1.02-2.52; p=0.04).
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