Key result
Symmetrical aortic valve calcification occurs more frequently in females and is independently predicted by LVOT calcification < 25 AU, lower mean pressure gradients, and a more horizontal aorta.
Why the study?
Aortic valve calcification distribution and predictors for leaflet calcification patterns in patients with severe tricuspid aortic valve stenosis undergoing TAVR were investigated.
What are the clinical, anatomical, and hemodynamic predictors of asymmetrical versus symmetrical aortic valve calcification distribution in patients with severe tricuspid aortic valve stenosis?
Observational (n=567)
No
What are the clinical, anatomical, and hemodynamic predictors of asymmetrical versus symmetrical aortic valve calcification distribution in patients with severe tricuspid aortic valve stenosis?
Odds Ratio: 1.81 (95% CI 1.09–3)
p-value: p=0.021
In patients with severe tricuspid aortic stenosis, symmetrical calcification is more common in females and associated with specific anatomical and hemodynamic factors, though predictive models show only moderate accuracy.
Symmetrical calcification was associated with female sex and specific predictors in severe AS; leaves open whether patterns affect TAVR planning or outcomes.
We investigated aortic valve calcification (AVC) distribution and predictors for leaflet calcification patterns in patients with severe tricuspid aortic valve stenosis undergoing transcatheter aortic valve replacement (TAVR). Patients undergoing routine multi-sliced computed tomography (MSCT) for procedural planning were enrolled. MSCT data were transferred to a dedicated workstation for evaluation (3mensio Structural Heart™, Pie Medical Imaging BV, Maastricht, The Netherlands) and analyzed. Participants were separated into asymmetrical (AC) and symmetrical (SC) leaflet calcification and potential predictors for calcification distribution were identified with univariate and multivariate regression analysis. 567 Participants with severe tricuspid AS were divided into asymmetrical (AC, n = 443; 78.1%) and symmetrical (SC, n = 124; 21.9%) AVC. In AC, the non-coronary cusp was the most calcified cusp (n = 238; 57.7%). SC is more common in females (AC/SC: 49.2% vs. 67.7%; p < 0.0001). AVC was more severe in patients with AC, who also have larger aortic root dimensions. Multivariate analysis depicted, inter alia, left ventricular outflow tract (LVOT) calcification < 25 Agatston units (OR 1.81 [1.09-3.00], p = 0.021), a mean pressure gradient < 36 mmHg (OR 1.77 [1.03-3.05], p = 0.039), and an annulo-apical angle > 67° (OR 1.68 [1.00-2.80], p = 0.049) as predictors for SC, although with only moderate predictive value. Data from this retrospective analysis indicate that SC occurs more frequently in females. The cumulative leaflet calcification burden is higher in patients with AC, who also present with larger aortic root dimensions. The predictive value for prominent calcification of different aortic valve cusps in AC patients was only low to moderate.Trial registration number: NCT01805739.
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Piayda et al. (2021) conducted an observational in Severe tricuspid aortic valve stenosis (n=567). Left ventricular outflow tract (LVOT) calcification < 25 Agatston units vs. LVOT calcification ≥ 25 Agatston units was evaluated on Symmetrical leaflet calcification (OR 1.81, 95% CI 1.09-3.00, p=0.021). Symmetrical aortic valve calcification occurs more frequently in females and is independently predicted by LVOT calcification < 25 AU, lower mean pressure gradients, and a more horizontal aorta.
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