Résumé
The clinical risk scores usually used for surgical valve replacement failed to accurately predict outcomes after TAVI and alternative risk parameters are lacking. We proposed to determine the prognostic value of aortic valve calcifications evaluated with CT-scan on outcome after TAVI.
This prospective monocentric study included 118 patients referred for TAVI for severe symptomatic aortic stenosis. The procedure was performed via transfemoral route using a balloon expandable (n=61) or a self expandable (n=57) valve. Pre-intervention non enhanced, ECG-gated, multislice CT-scan was done in all patients. Aortic valve calcifications were evaluated using the Agatston calcium score (CS). Procedure-related complications were evaluated and clinical outcome was analysed using a composite criteria (mortality, stroke, myocardial infarction, heart failure) at 30-day follow-up.
Mean CS was 4092±2176. At 30-day follow-up, mortality was 6.8% (n=8) and 28 patients (23%) have presented the composite criteria. On univariate analysis (table), CS appears to be the best predictor of adverse outcome after TAVI, significantly higher in patients who have presented the composite criteria (5785 vs 3565 p<0,001). A CS threshold of 6000 allowed to define patients at risk of adverse outcome with a sensitivity of 50% and a specificity of 97%. On multivariate analysis, the only predictors of adverse outcome were dislipidemia (OR 12; IC95 2,7–54,7), BMI (OR 0,8; IC95 0,7-0,95) and CS>6000 (OR 106; IC95 15,5-727,6).
During the follow-up, the 5 patients who have developped a moderate to severe aortic regurgitation had a significantly higher CS than those who developped none or mild regurgitation (10121 vs 3809, p<0,001).
High degree of calcification of aortic valve, easily quantifiable on the pre-operative CT-scan appears to be an important prognostic parameter which should be considered by the Heart Team in the decision making.Abstract 0486 – Table: Predictors of adverse outcome after TAVIPresence of composite criteria n=28Absence of composite criteria n=90pEuroScore 1 (%)24,96±11,4818,55±10,990,013Dislipidemia n(%)12 (43)23 (26)0,08Body mass index (BMI) n(%)24,21±4,0127,33±5,510,01CoreValve prothesis n(%)18 (64)39 (43)0,056Calcium score5875,71±3285,843565,78±1331,18<0,001