Journal of Cardiovascular Imaging

Korean Society of Echocardiography (한국심초음파학회)
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Distribution of Aortic Root Calcium in Relation to Frame Expansion and Paravalvular Leakage After Transcatheter Aortic Valve Implantation (TAVI): An Observational Study Using a Patient-specific Contrast Attenuation Coefficient for Calcium Definition and Independent Core Lab Analysis of Paravalvular Leakage

  • Nahid El Faquir (Department of Cardiology, Thoraxcenter, Erasmus Medical Center) ;
  • Quinten Wolff (Department of Cardiology, Thoraxcenter, Erasmus Medical Center) ;
  • Rafi Sakhi (Department of Cardiology, Thoraxcenter, Erasmus Medical Center) ;
  • Ben Ren (Department of Cardiology, Thoraxcenter, Erasmus Medical Center) ;
  • Zouhair Rahhab (Department of Cardiology, Thoraxcenter, Erasmus Medical Center) ;
  • Sander van Weenen (Department of Cardiology, Thoraxcenter, Erasmus Medical Center) ;
  • Patrick Geeve (Department of Cardiology, Thoraxcenter, Erasmus Medical Center) ;
  • Ricardo P J Budde (Department of Radiology and Nuclear Medicine, Erasmus Medical Center) ;
  • Eric Boersma (Department of Cardiology, Thoraxcenter, Erasmus Medical Center) ;
  • Joost Daemen (Department of Cardiology, Thoraxcenter, Erasmus Medical Center) ;
  • Nicolas M van Mieghem (Department of Cardiology, Thoraxcenter, Erasmus Medical Center) ;
  • Peter P de Jaegere (Department of Cardiology, Thoraxcenter, Erasmus Medical Center)
  • Received : 2021.08.26
  • Accepted : 2022.05.15
  • Published : 2022.10.27
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Abstract

BACKGROUND: Calcium is a determinant of paravalvular leakage (PVL) after transcatheter aortic valve implantation (TAVI). This is based on a fixed contrast attenuation value while X-ray attenuation is patient-dependent and without considering frame expansion and PVL location. We examined the role of calcium in (site-specific) PVL after TAVI using a patient-specific contrast attenuation coefficient combined with frame expansion. METHODS: 57 patients were included with baseline CT, post-TAVI transthoracic echocardiography and rotational angiography (R-angio). Calcium load was assessed using a patient-specific contrast attenuation coefficient. Baseline CT and post-TAVI R-angio were fused to assess frame expansion. PVL was assessed by a core lab. RESULTS: Overall, the highest calcium load was at the non-coronary-cusp-region (NCR, 436 mm3) vs. the right-coronary-cusp-region (RCR, 233 mm3) and the left-coronary-cusp-region (LCR, 244 mm3), p < 0.001. Calcium load was higher in patients with vs. without PVL (1,137 vs. 742 mm3, p = 0.012) and was an independent predictor of PVL (odds ratio, 4.83, p = 0.004). PVL was seen most often in the LCR (39% vs. 21% [RCR] and 19% [NCR]). The degree of frame expansion was 71% at the NCR, 70% at the RCR and 74% at the LCR without difference between patients with or without PVL. CONCLUSIONS: Calcium load was higher in patients with PVL and was an independent predictor of PVL. While calcium was predominantly seen at the NCR, PVL was most often at the LCR. These findings indicate that in addition to calcium, specific anatomic features play a role in PVL after TAVI.

Keywords

Acknowledgement

Dr. Daemen received institutional grant/research support from Astra Zeneca, Abbott Vascular, Boston Scientific, ACIST Medical, Medtronic, Pie Medical, and ReCor Medical, and consultancy and speaker fees from ACIST Medical, Boston Scientific, ReCor Medical, Pie Medical and Medtronic. Prof. Van Mieghem reports grants from Abbott, grants from Boston Scientific, grants from Edwards Lifesciences, grants from Medtronic, grants from Daiichi Sankyo, grants from PulseCath BV and grants from Teleflex, outside the submitted work. Dr. Wolff reports nonfinancial support from Siemens Healthcare, during the conduct of the study.

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