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Willemink MJ, Maret E, Moneghetti KJ, Kim JB, Haddad F, Kobayashi Y, Nishi T, Nieman K, Cauwenberghs N, Kuznetsova T, Higashigaito K, Sailer AM, Yeung AC, Lee AM, Miller DC, Fischbein M, Fearon WF, Fleischmann D. Incremental Value of Aortomitral Continuity Calcification for Risk Assessment after Transcatheter Aortic Valve Replacement. Radiol Cardiothorac Imaging 2019; 1:e190067. [PMID: 33778530 DOI: 10.1148/ryct.2019190067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 08/10/2019] [Accepted: 09/05/2019] [Indexed: 11/11/2022]
Abstract
Purpose To investigate the association of aortomitral continuity calcification (AMCC) with all-cause mortality, postprocedural paravalvular leak (PVL), and prolonged hospital stay in patients undergoing transcatheter aortic valve replacement (TAVR). Materials and Methods The authors retrospectively evaluated 329 patients who underwent TAVR between March 2013 and March 2016. AMCC, aortic valve calcification (AVC), and coronary artery calcification (CAC) were quantified by using preprocedural CT. Pre-procedural Society of Thoracic Surgeons (STS) score was recorded. Associations between baseline AMCC, AVC, and CAC and 1-year mortality, PVL, and hospital stay longer than 7 days were analyzed. Results The median follow-up was 415 days (interquartiles, 344-727 days). After 1 year, 46 of the 329 patients (14%) died and 52 (16%) were hospitalized for more than 7 days. Of the 326 patients who underwent postprocedural echocardiography, 147 (45%) had postprocedural PVL. The CAC score (hazard ratio: 1.11 per 500 points) and AMCC mass (hazard ratio: 1.13 per 500 mg) were associated with 1-year mortality. AVC mass (odds ratio: 1.93 per 100 mg) was associated with postprocedural PVL. Only the STS score was associated with prolonged hospital stay (odds ratio: 1.19 per point). Conclusion AMCC is associated with mortality within 1 year after TAVR and substantially improves individual risk classification when added to a model consisting of STS score and AVC mass only.Supplemental material is available for this article.© RSNA, 2019See also the commentary by Brown and Leipsic in this issue.
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Affiliation(s)
- Martin J Willemink
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - Eva Maret
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - Kegan J Moneghetti
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - Juyong Brian Kim
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - Francois Haddad
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - Yukari Kobayashi
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - Takeshi Nishi
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - Koen Nieman
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - Nicholas Cauwenberghs
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - Tatiana Kuznetsova
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - Kai Higashigaito
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - Anna M Sailer
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - Alan C Yeung
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - Anson M Lee
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - D Craig Miller
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - Michael Fischbein
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - William F Fearon
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - Dominik Fleischmann
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
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