Author + information
- Lionel Lloyd Tasteta,b,
- Maurice Enriquez-Saranoa,b,
- Romain Capouladea,b,
- Youssef Maaloufa,b,
- Philip Araoza,b,
- Louis Simarda,b,
- Mylène Shena,b,
- Hector Michelenaa,b,
- Eric Larosea,b,
- Marie Arsenaulta,b,
- Élisabeth Bédarda,b,
- Jordan Millera,b,
- Philippe Pibarota,b and
- Marie-Annick Clavela,b
Background: Recent studies showed that the assessment of aortic valve calcification (AVC) by multidetector computed tomography (MDCT) is useful to corroborate hemodynamic severity of aortic stenosis (AS). AVC load might provide incremental value beyond clinical and echocardiographic parameters of AS severity to predict hemodynamic progression and occurrence of valve-related events.
Methods: Three hundred twenty three patients (68±13 yrs, 70% men) with AS were prospectively enrolled in 2 academic centers. Hemodynamic AS progression was assessed by annualized increase in mean gradient (MG) measured by echocardiography. AVC was measured by MDCT using the Agatston method and was indexed to the cross-sectional area of the aortic annulus to obtain AVC density (AVCd).
Results: Patients with rapid progression (MG progression ≥3.0 mmHg/yr, median for the cohort) had higher AVCd at baseline as compared to those with slow progression (median [IQR]: AVCd: 322 [160-508] vs 175 [84-309] AU/cm2; p<0.0001). Hemodynamic AS progression rate did not differ between women and men (MG: 3.4[0.7-6.4] vs 2.5[0.8-5.7] mmHg/yr; p=0.48), and was associated with baseline AVCd in both sexes (p<0.0001). The slope of correlation between baseline AVCd and MG progression was steeper in women than in men (pancova=0.003). After multivariable adjustment for age, sex, hypertension, dyslipidaemia, diabetes, renal disease, NYHA III-IV and baseline MG, baseline AVCd remained an independent predictor of faster AS progression. During follow-up (3.5±2.1 years), there were 132 valve-related events (124 aortic valve replacement and 8 cardiac deaths). After multivariable adjustment, severe AVCd (>300 AU/cm2 in women and >500 AU/cm2 in men) (HR: 2.88 [1.82-4.55]; p<0.0001) was an independent predictor of events and provided significant incremental prognostic value to hemodynamic valve evaluation alone (net reclassification index=27%; p=0.0005).
Conclusions: AVC load by MDCT is an independent predictor of faster AS progression and related events. AVC load, specifically interpreted for sex, is a strong marker of faster AS progression and should be included in clinical decisions for management and follow-up in AS
Moderated Poster Contributions
Valvular Heart Disease Moderated Poster Theater, Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:10 a.m.
Session Title: Novel Determinants of Outcomes in VHD
Abstract Category: 36. Valvular Heart Disease: Clinical
Presentation Number: 1132M-03
- 2017 American College of Cardiology Foundation