Clinical impact of mitral calcium volume in patients undergoing transcatheter aortic valve implantation.

Okuno, Taishi; Brugger, Nicolas; Asami, Masahiko; Heg, Dik; Siontis, George C M; Winkel, Mirjam G; Lanz, Jonas; Gräni, Christoph; Huber, Adrian; Stortecky, Stefan; George, Isaac; Kodali, Susheel; Pilgrim, Thomas; Windecker, Stephan; Khalique, Omar K; Praz, Fabien (2020). Clinical impact of mitral calcium volume in patients undergoing transcatheter aortic valve implantation. (In Press). Journal of cardiovascular computed tomography Elsevier 10.1016/j.jcct.2020.10.003

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BACKGROUND

Mitral annular calcification (MAC) has been associated with mitral valve (MV) disease and cardiovascular events in patients undergoing transcatheter aortic valve implantation (TAVI). We aimed to investigate the incidence and impact of mitral calcium volume (MCV) quantified by multidetector computed tomography (MDCT) on MV function and clinical outcomes after TAVI.

METHODS

Consecutive patients with exploitable echocardiography and MDCT performed during TAVI screening were enrolled in this retrospective analysis. Mitral calcium was assessed visually and measured using a semi-automatic tool developed for the aortic valve in an off-label fashion.

RESULTS

MCV >0 mm3 was found in 65% of the 875 included patients. Patients with calcification were older (82 ± 6 versus 81 ± 7; P = 0.002) and had high prevalence of renal dysfunction (69% versus 61%; P = 0.017) and mitral stenosis (25% versus 4%, P < 0.001). MCV correlated well with visual MAC severity (r = 0.94; P < 0.001), but showed a greater predictive value for mitral stenosis (AUC = 0.804 vs. 0.780, P = 0.012) , while it was not a predictor of mitral regurgitation (AUC = 0.514). Correlations were found between MCV and echocardiographic parameters including MV area, mean transmitral gradient, and pressure half-time (P < 0.001 for all). MCV did not impact on cardiovascular mortality or new permanent pacemaker implantation after TAVI.

CONCLUSIONS

Calcification of the mitral apparatus is common in TAVI candidates and results in mitral stenosis in 25% of the patients. Increasing MCV predicts mitral stenosis, but had no impact on clinical outcomes following TAVI.

CLINICAL TRIAL REGISTRATION

NCT01368250.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern

UniBE Contributor:

Okuno, Taishi; Brugger, Nicolas Jacques; Asami, Masahiko; Heg, Dierik Hans; Siontis, Georgios; Winkel, Mirjam Gauri; Lanz, Jonas; Gräni, Christoph; Huber, Adrian Thomas; Stortecky, Stefan; Pilgrim, Thomas; Windecker, Stephan and Praz, Fabien

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1934-5925

Publisher:

Elsevier

Language:

English

Submitter:

Maria de Fatima Henriques Bernardo

Date Deposited:

02 Nov 2020 14:39

Last Modified:

03 Nov 2020 14:54

Publisher DOI:

10.1016/j.jcct.2020.10.003

PubMed ID:

33121904

Uncontrolled Keywords:

Aortic stenosis Mitral annular calcification Mitral regurgitation Mitral stenosis Mitral valve Transcatheter aortic valve implantation

BORIS DOI:

10.7892/boris.147690

URI:

https://boris.unibe.ch/id/eprint/147690

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