Valvular & structural heart disease
Calcification of surgical aortic bioprostheses and its impact on clinical outcome
Authors' conclusion
CT scan is a reliable tool to assess BP leaflet calcification. An AVC > 100 AU is tightly associated with SVD and it is a strong predictor of overall mortality and cardiovascular events.
Study context
- Population
- Patients with surgical aortic valve bioprostheses (replacement 6.4 ± 4.3 years earlier) assessed by in vivo computed tomography (CT), 2011–2019342 with interpretable CT
- Participants
- 361 patients
- Exposure
- Aortic valve calcification (AVC) >100 Agatston units (AU) vs AVC ≤100 AU on CT of surgical aortic bioprostheses
- AVC > 100 AUn = 147
- AVC ≤ 100 AUn = 195reference
- Outcome
- In vivo and ex vivo bioprosthesis AVC by CT and its prognostic value
Main finding
As reported in the abstract
AVCHazard ratio (95% CI)P value
Overall mortality, multivariable
1.16(1.04–1.29)
P = 0.006CV mortality, multivariable
1.22(1.04–1.43)
P = 0.013CV events, multivariable
1.28(1.16–1.41)
P < 0.0001Re-intervention, multivariable
1.15(1.06–1.25)
P < 0.0001- Mean in vivo AVC
- 307 ± 500 AU
Observational data: associations, not effects.
Further findings
AVC after adjustment for Stage 2-3 structural valve degeneration (SVD)
| HR (95% CI) | P value | ||
|---|---|---|---|
| AVCOverall mortality | 1.20 (1.04–1.39) | P = 0.015 | |
| AVCCV events | 1.25 (1.09–1.43) | P = 0.001 | |
| 0.512Hazard ratio (log scale) |
| Outcome | P value |
|---|---|
| AVC by SVD statusSVD vs No SVD | P < 0.0001 |
- Diagnosis of Stage 2-3 SVD by AVC > 100 AU
- 43% · 147
- AVC by SVD status: SVD mean 562 (SD 570) AU
- AVC by SVD status: No SVD mean 13 (SD 43) AU
- AVC by SVD status: 183 (53.5%) with SVD
In vivo vs ex vivo AVC correlation
- R
- 0.88
- P
- P < 0.0001
- 37 explanted bioprostheses (BPs)
Original publication
Calcification of surgical aortic bioprostheses and its impact on clinical outcome. Eur Heart J Cardiovasc Imaging. Published 12 April 2024. doi:10.
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