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Aorta calcification burden: Towards an integrative predictor of cardiac outcome after transcatheter aortic valve implantation

  • Brahim Harbaoui
    Correspondence
    Corresponding author. Cardiology Department, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69004, Lyon. France.
    Affiliations
    From the Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France

    Université de Lyon, CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, France
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  • Mathieu Montoy
    Affiliations
    From the Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France
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  • Paul Charles
    Affiliations
    From the Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France
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  • Loic Boussel
    Affiliations
    Université de Lyon, CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, France

    Radiology Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France
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  • Hervé Liebgott
    Affiliations
    Université de Lyon, CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, France
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  • Nicolas Girerd
    Affiliations
    INSERM, Centre d’Investigations Cliniques-1433, and INSERM U1116 & CHU Nancy, Institut Lorrain du Cœur et des Vaisseaux, Vandoeuvre lès Nancy, France
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  • Pierre-Yves Courand
    Affiliations
    From the Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France

    Université de Lyon, CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, France
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  • Pierre Lantelme
    Affiliations
    From the Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France

    Université de Lyon, CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, France
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      Highlights

      • We studied associations of aortic calcifications and outcomes after TAVI.
      • Total aortic calcifications predicted cardiac mortality and all-cause mortality.
      • Calcifications of all aorta segments predicted cardiac mortality.
      • Only Ascending aorta calcifications predicted heart failure.
      • Assessing aortic calcifications should be considered for risk stratification before TAVI.

      Abstract

      Objective

      The principal objective was to determine the effect of total aortic calcification (TAC) burden on outcomes (cardiac mortality, all-cause mortality, and heart failure (HF)) after transcatheter aortic valve implantation (TAVI). The secondary aim was to assess the contribution of each segment of the aorta to these outcomes.

      Background

      Indications for TAVI are increasing in number. Even after procedural success, however, some patients die soon afterwards, indicating the futility of TAVI in certain cases.

      Methods

      Aortic calcifications were measured on computed tomography in 164 patients treated by TAVI. TAC, ascending aortic calcification (AsAC), descending aorta calcifications, and abdominal aorta calcifications were expressed as tertiles and their prognostic values were assessed in a multivariable cox analysis adjusted for major confounders including EuroSCORE.

      Results

      Median duration of follow-up was 565 (interquartile range: 246 to 1000) days. TAC (tertile3 vs. tertile1) was significantly and strongly associated with cardiac mortality (hazard ratio [HR]: 16.74; 95% confidence interval [CI]: 2.21 to 127.05; p = 0.006) and all-cause mortality (HR: 2.39; 95% CI: 1.18 to 4.84; p = 0.015) but not with HF (HR: 1.84; 95% CI: 0.87 to 3.90; p = 0.110). Each segment was associated with cardiac mortality, while only AsAC (tertile 3 vs. tertile 1) appeared predictive of HF (hazard ratio: 2.29; 95% CI: 1.12 to 4.66; p = 0.023).

      Conclusions

      TAC is an integrative predictor of cardiac and all-cause mortality after TAVI. It should be included in the assessment of patients before TAVI in order to predict cardiac outcome after valve replacement and avoid futile interventions.

      Keywords

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