Introduction: Transcatheter aortic valve implantation (TAVI) is now a standard treatment for patients with inoperable severe aortic stenosis (AS). However, less information is available for predictive factors for long-term prognosis. Using CT analysis, aortic valve calcification volume index (ACV index) calculated as a quotient of aortic valve calcium volume divided by annulus area has been proposed as a novel index of AS severity.
Hypothesis: We hypothesized that ACV index related with prognosis after TAVI.
Methods: To elucidate prognosis after successful transfemoral (TF-)TAVI and its predictive factors, consecutive 114 patients performed TF-TAVI in our institute from December 2013 to August 2016 were analyzed. The substance whose CT value is over 450(HU) is regarded as ACV.
Results: Median follow-up period was 587.5±258.4 days. We excluded 1 patient with annulus rupture, 2 patients with surgical AVR conversion and 2 patients with no contrast CT data were excluded from analysis. Finally, a total of 109 patients were examined. There were 17 death cases in total during the follow-up period. Cardiac death occurred in 2 cases; 1 sudden death and 1 acute decompensated heart failure. Heart failure needed hospitalization occurred in 7 cases. Univariate analysis revealed pretreatment aortic valve pressure gradient and peak velocity, STS risk score, presence of atrial fibrillation, paradoxical low flow low gradient AS, ACV and ACV index were associated with heart failure events. In Cox proportional hazard model, atrial fibrillation (risk ratio: 6.89, 95% confidence interval: 1.50 to 35.43, p=0.0145), paradoxical low flow low gradient AS (risk ratio: 10.71, 95% confidence interval: 2.18 to 79.06, p=0.034) and ACV index (/100) (risk ratio: 0.40, 95% confidence interval: 0.18 to 0.72, p=0.0007) were independent predictors. of heart failure.
Conclusions: Even after successful TF-TAVI, patients with lower ACV index must be paid special attention to avoid heart failure events. TF-TAVI is sure to have more positive impacts on prognosis in patients with high ACV index.