Abstract 17124: Aortic Valve Calcification as a Predictor of Post-TAVR Pacemaker Dependence

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Esseim Sharma ◽  
Antony F Chu ◽  
Brian D McCauley
Keyword(s):  
Aortic Valve ◽  
Rhode Island ◽  
Aortic Valve Calcification ◽  
Valve Calcification ◽  
Tissue Edema ◽  
Number Of Patients ◽  
Increased Risk ◽  
Rv Pacing ◽  
Enhanced Computed Tomography

Introduction: Atrioventricular block requiring permanent pacemaker (PPM) implantation is a common complication of TAVR. Our group has previously reported that a significant number of patients receiving PPM immediately post-TAVR do not require right ventricular (RV) pacing at 30 days. The mechanism of AV block during TAVR is not fully understood, but is thought to partly be due to the mechanical stress of TAVR deployment and resultant tissue edema, resulting in possible injury to the nearby compact AV node. Aortic valve calcification (AVC) may worsen this condition and has been associated with an increased risk for post-TAVR PPM implantation. We performed a retrospective analysis to determine if AVC is predictive for long-term RV pacing in post-TAVR pacemaker patients at 30 days. Methods: Prospectively collected data of 262 consecutive patients who underwent TAVR with placement of a balloon-expandable valve at Rhode Island Hospital from March 2012 to October 2016 were analyzed. AVC data were derived from contrast-enhanced computed tomography and characterized by leaflet sector and region. Results: A total of 25 patients (11.1%) required post-TAVR PPM implantation. Seventeen patients did not require RV pacing at 30 days. Nine of these 17 patients had no RV pacing requirement within 10 days. Non-coronary leaflet (NCL) calcium volume was significantly higher in patients who were pacemaker dependent at 30 days ( p =0.01) and a calcium volume of >200mm 3 in the NCL was significantly associated with pacemaker dependence at 30 days (OR 51.9, 2.3-1170.2, p = 0.01). Pre-existing RBBB (OR 105.4, 4.52-2458.5, p=0.0002), bifascicular block (OR 12.50, 1.60-97.65, p=0.02), intra-procedural complete heart block (OR 12.83, 1.26-130.52, p =0.03), and QRS duration >120ms (OR 70.43, 3.23-1535.22, p=0.0002) were also significantly associated with pacemaker dependence at 30 days. Conclusions: Quantification of AVC by non-coronary leaflet calcium volume was found to be a novel predictor for RV pacing dependence at 30 days. The association of NCL calcification and pacemaker dependence may be related to the proximity of the conduction bundle to the non-coronary leaflet. Further studies are necessary to improve risk prediction for long-term RV pacing requirements following TAVR.

Abstract 2655: Correlates Of Aortic Valve Calcification In Aortic Stenosis: Insights From The Astronomer Study

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Kwan Chan ◽  
James Tam ◽  
Randall Sochowski ◽  
Jean Dumesnil ◽  
Peter Giannoccaro ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Common Finding ◽  
Aortic Valve Calcification ◽  
Cholesterol Lowering ◽  
Valve Calcification ◽  
Increased Risk ◽  
Male Sex

Aortic valve calcification (AVC), a common finding in aortic stenosis (AS), is a predictor of rapid AS progression and increased risk of cardiac events. We evaluated clinical, echocardiographic and biochemical correlates of AVC to gain insight into pathogenesis and to identify potential targets for intervention. Methods: The ASTRONOMER study (Aortic Stenosis Progression Observation: Measuring Effects of Rosuvastatin) is a randomized trial to assess cholesterol lowering using rosuvastatin on AS progression in mild to moderate AS. Patients with indication for cholesterol lowering were excluded. Severity of AVC was classified as none, mild, moderate and severe according to published criteria. Results: 272 patients (167 men, 105 women; mean age 58.1±13.6 years) have been enrolled with peak and mean AV gradients 41±11 and 23±8 mmHg respectively. Patients with none or mild AVC were compared with patients with moderate or severe AVC (Table ). ACE-I= angiotensin converting enzyme inhibitor, BAV=bicuspid aortic valve, BP=blood pressure, HDL-C=high-density lipoprotein cholesterol, LDL-C= low-density lipoprotein cholesterol, MAC=mitral annular calcification. Regression analysis showed that AVC was associated with age (p<0.001), male sex (p=0.01), systolic BP (p=0.002), LDL-C (p=0.05), MAC (p=0.01) and tricuspid AV (p=0.001). With adjustment for age, correlates of AVC were male sex with odds ratio (OD) 2.04, p<0.01, systolic BP (OD=1.02, p=0.096), and LDL-C (OD 1.44, p=0.077). Conclusions: In patients with AS, age and male sex are the main correlates of AVC. After adjusting for age, AVC is not associated with AV morphology but appears to be related to male sex, BP and LDL-C. Thus BP and LDL-C are promising modifiable targets to prevent AVC which in turn should reduce AS progression.

Abstract 20510: Aortic Valve Calcium Score for Paravalvular Aortic Insufficiency (AVCS II) Study in Transapical Aortic Valve Implantation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Martin Haensig ◽  
Lukas Lehmkuhl ◽  
Borek Foldyna ◽  
Axel Linke ◽  
Chirojit Mukherjee ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Aortic Valve ◽  
Calcium Score ◽  
Aortic Valve Calcification ◽  
Valve Calcification ◽  
Contrast Enhanced ◽  
Aortic Valve Implantation ◽  
Enhanced Computed Tomography ◽  
Valve Implantation ◽  
Contrast Enhanced Computed Tomography

Introduction: Transapical-aortic valve implantation (TA-AVI) has evolved into a routine procedure in selected elderly high-risk patients. However, more-than-mild paravalvular leaks remain a significant drawback of current TAVI systems. The aim was to study the impact of native aortic valve calcification on paravalvular leaks in cardiac contrast-enhanced computed tomography (CT). Methods: The degree and distribution of native valve calcification were quantified using an Aortic Valve Calcium Score (AVCS) for each cusp separately (3mensio Valves™ workstation, version 7.0, 3mensio Medical Imaging B.V., Netherlands). To exclude an artificial increase of the AVCS due to the presence of contrast material, we used a threshold for density [mean aortic density + 2*D] and volume [0, 3, 5, 25 and 50 mm 3 ] of calcification. AVCS was compared to the rate of paravalvular leaks, assessed intraoperatively by echocardiography and root angiography. Results: Eighty-eight consecutive patients prior to TA-AVI with preoperative CT aged 80.0 ± 5.7 years, 51.1 % female were included. Three prosthesis sizes were used for annular diameters up to 23 mm (n = 29), 26 mm (n = 45) and 29 mm (n = 14). Mean log. EuroSCORE was 24.6 ± 15.4 % and mean STS-Score was 8.4 ± 8.3 %. The mean AVCS in patients without paravalvular leaks (n = 42) was 606.4 ± 374.3; with mild paravalvular leaks (n = 39) was 761.2 ± 530.4; and with moderate paravalvular leaks (n = 5) was 792.4 ± 515.3 with the highest calcification in the non-coronary cusp. There was no significant association between the total AVCS and paravalvular leaks (χ 2 -statistic = 2.9; P = 0.13, 551 hounsfield units). The additional use of the volume-based threshold did not lead to an increase of the association between the AVCS and paravalvular leakages. Paravalvular leaks were significantly associated with the degree (r Spearman = 0.34; χ 2 -statistic = 10.0; P = 0.02) and location of eccentric calcified plaques. Conclusions: Quantification of aortic valve calcification in contrast enhanced computed tomography shows only a weak correlation with paravalvular leakage and is therefore not reliable as a predictor, respectively. The degree of eccentric cusp calcification was significantly associated with the occurrence and location of paravalvular leaks.

scholarly journals Aortic Valve Calcification is Associated with Future Cognitive Impairment

2021 ◽  
pp. 1-7
Author(s):  
Hojune E. Chung ◽  
Jessica Chen ◽  
Dhairyasheel Ghosalkar ◽  
Jared L. Christensen ◽  
Alice J. Chu ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Aortic Valve ◽  
Lung Cancer Screening ◽  
Continuous Variable ◽  
Smoking History ◽  
Event Analysis ◽  
Aortic Valve Calcification ◽  
Valve Calcification ◽  
Ckd Stage ◽  
New Diagnosis

Background: While an association between atherosclerosis and dementia has been identified, few studies have assessed the longitudinal relationship between aortic valve calcification (AVC) and cognitive impairment (CI). Objective: We sought to determine whether AVC derived from lung cancer screening CT (LCSCT) was associated with CI in a moderate-to-high atherosclerotic risk cohort. Methods: This was a single site, retrospective analysis of 1401 U.S. veterans (65 years [IQI: 61, 68] years; 97%male) who underwent quantification of AVC from LCSCT indicated for smoking history. The primary outcome was new diagnosis of CI identified by objective testing (Mini-Mental Status Exam or Montreal Cognitive Assessment) or by ICD coding. Time-to-event analysis was carried out using AVC as a continuous variable. Results: Over 5 years, 110 patients (8%) were diagnosed with CI. AVC was associated with new diagnosis of CI using 3 Models for adjustment: 1) age (HR: 1.104; CI: 1.023–1.191; p = 0.011); 2) Model 1 plus hypertension, hyperlipidemia, diabetes, CKD stage 3 or higher (glomerular filtration rate <  60 mL/min) and CAD (HR: 1.097; CI: 1.014–1.186; p = 0.020); and 3) Model 2 plus CVA (HR: 1.094; CI: 1.011–1.182; p = 0.024). Sensitivity analysis demonstrated that the association between AVC and new diagnosis of CI remained significant upon exclusion of severe AVC (HR: 1.100 [1.013–1.194]; p = 0.023). Subgroup analysis demonstrated that this association remained significant when including education in the multivariate analysis (HR: 1.127 [1.030–1.233]; p = 0.009). Conclusion: This is the first study demonstrating that among mostly male individuals who underwent LCSCT, quantified aortic valve calcification is associated with new diagnosis of CI.

Synthetic Hydrogels Reveal the Role of the Matrix Microenvironment on Aortic Valve Calcification

2021 ◽  
Vol 5 (sup1) ◽  
pp. 73-73
Author(s):  
Megan E. Schroeder ◽  
Andrea Gonzalez Rodriguez ◽  
Kelly F. Speckl ◽  
Cierra J. Walker ◽  
Firaol S. Midekssa ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Calcification ◽  
Valve Calcification ◽  
The Matrix ◽  
Synthetic Hydrogels
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