Value of Post-/Pre-Procedural Aortic Regurgitation Ratio Vs. Pre-Procedural Aortic Valve Calcium Score to Predict Moderate to Severe Paravalvular Leak Requiring Post-Dilation After Transcatheter Aortic Valve Implantation

Overview

Journal J Clin Med

Specialty General Medicine

Date 2023 Dec 23

PMID 38137804

Authors

Roman Uebelacker

Simon S Martin

Mariuca Vasa-Nicotera

Silvia Mas-Peiro

Affiliations

Soon will be listed here.

Abstract

Background And Aim: Tools that assist interventionists in selecting patients for post-dilation (PD) are needed. We aimed to assess whether pre-interventional aortic valve calcium (AVC) or the peri-interventional aortic regurgitation (ARI) ratio is a better predictor for a more than mild paravalvular leak (PVL) requiring PD after TAVI.

Methods: Patients undergoing TAVI with available data on AVC derived from MSCTs and the ARI ratio derived from peri-interventional hemodynamic curves were studied. The main outcome was moderate-to-severe PVL requiring PD.

Results: In 237 patients, more than mild PVL after valve deployment was present in 25.7%. PD was performed in 65 patients. The median (IQR) total AVC was 390.5 (211.5-665.4) mm. All calcification values were significantly higher in patients who underwent PD. The median (IQR) individual threshold was 600 (550-685) Hus. The overall ARI ratio was 0.78 (0.61-0.96), with values being significantly lower in patients who underwent PD: 0.61 (0.49-0.80) vs. 0.82 (0.69-0.99) ( < 0.001). Both the ARI ratio (OR [95%CI] 0.053 [0.014-0.203]; < 0.001) and AVC (1.01 [1.000-1.002]; = 0.015) predicted PD need. ROC curves showed higher discrimination for the ARI ratio (AUC 0.73) than for any calcification parameter (all AUCs ≤ 0.62).

Conclusions: The ARI ratio provides interventionists with a powerful predictive tool for PVL requiring PD after TAVI that is beyond the predictive value of pre-procedural valve calcification derived from MSCT.

Citing Articles

Aortic Valve Calcium Score: Applications in Clinical Practice and Scientific Research-A Narrative Review.

Gac P, Jaworski A, Grajnert F, Kicman K, Trejtowicz-Sutor A, Witkowski K J Clin Med. 2024; 13(14).

PMID: 39064103 PMC: 11277735. DOI: 10.3390/jcm13144064.

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