After TAVI, lower (<1400 cAU) and higher (>1700 cAU) aortic valve calcification were associated with increased long-term mortality (HR 1.372; 95% CI 1.007-1.871; P=0.045).
Cohort (n=1,262)
Does the calcification load of the aortic valve and infrarenal aorta predict long-term mortality in patients after successful TAVI?
After successful TAVI, aortic valve calcification demonstrates a non-linear j-shaped association with long-term mortality, independent of infrarenal aortic calcification.
Hazard Ratio: 1.372 (95% CI 1.007–1.871)
p-value: p=0.045
Abstract Background Calcification of both the aortic valve and the aorta are prognostic markers in patients with aortic valve stenosis (AS). Whether the prognostic impact of valvular calcification persists after successful transcatheter aortic valve implantation (TAVI) is still a matter of debate. Objectives Defining long-term risk groups after TAVI by assessment of calcification load of the aortic valve and the infrarenal aorta. Methods In this retrospective analysis, we analysed the association between contrast enhanced calculated aortic valve Agatston Score Units (cAU) and infrarenal aortic calcification volume as assessed by computed tomography angiography (CTA) with long-term mortality of at least 30 days after TAVI. Results We investigated 1262 patients (age 82.6±5.5 years, 59% female) who underwent TAVI between January 2012 and December 2017. During a follow-up of 3.26 years (IQR 2.01-5.02), patients with lower as well as higher aortic valve calcification (1400 and 1700cAU) showed a higher risk of mortality in spline function analysis. This higher-risk group showed an increased risk of mortality in univariable (HR1.428 (CI1.061;1.921, P=0.019) and both multivariable Cox regression models (HR1.372 (CI1.007;1.871, P=0.045 and 1.447 (CI 1.065;1.966, P= 0.018), respectively). Infrarenal aortic calcification as dichotomized variable by the median of 1723mm³ was associated with mortality in univariable (HR1.367 (CI1.152;1.622), P0.001) and multivariable Cox regression model A (HR 1.196 (CI1.005;1.424), P= 0.044), but not in model B (HR 1.181 (CI0.989;1.411, P=0.065). Conclusion After successful TAVI, aortic valve calcification is a non-linear j-shaped risk factor of mortality and is independent of infrarenal aortic calcification as a surrogate for body vessel calcification.Figure 1 Spline Curve Figure 2 Kaplan Meier
Hein et al. (Thu,) conducted a cohort in Severe aortic stenosis (n=1,262). Aortic valve calcification (<1400 and >1700 cAU) vs. Intermediate aortic valve calcification was evaluated on Long-term mortality (HR 1.372, 95% CI 1.007-1.871, p=0.045). After TAVI, lower (<1400 cAU) and higher (>1700 cAU) aortic valve calcification were associated with increased long-term mortality (HR 1.372; 95% CI 1.007-1.871; P=0.045).
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