Aortic annulus dimensions and leaflet calcification from contrast MSCT predict the need for balloon post-dilatation after TAVI with the Medtronic CoreValve prosthesis

作者：Schultz Carl^*; Rossi Alexia; van Mieghem Nicolas; van der Boon Robert; Papadopoulou Stella Lida; van Domburg Ron; Moelker Adriaan; Mollet Nico; Krestin Gabriel; van Geuns Robert Jan; Nieman Koen; de Feyter Pim; Serruys Patrick; de Jaegere Peter

来源：Eurointervention, 2011, 7(5): 564-572.

DOI：10.4244/eijv7i5a92

• aorta stenosis
• valvuloplasty
• valvular heart disease
• imaging

Aims: We compared the measurement of aortic leaflet calcification on contrast and non-contrast MSCT and investigated predictors of the need for balloon post-dilatation after TAVI.
Methods and results: In 110 patients, who had TAVI with a Medtronic CoreValve prosthesis (MCS) for symptomatic aortic stenosis, calcification of the aortic root was measured on non-contrast MSCT (conventionally) and on contrast MSCT (signal attenuation >450 Houndsfield units). Calcium volume was underestimated on contrast- when compared to non-contrast MSCT: median (IQ-range)=759 (466 to 1295) vs. 2016 (1376 to 3262) and the difference between the two methods increased with higher calcium volumes (correlation coefficient r=0.90). Calcium mass was only slightly underestimated on contrast vs. non-contrast MSCT: median (IQ-range)=441 (268 to 809) vs. 555 (341 to 950) and there was no association between the differences and increasing calcium mass (r=0.17). Balloon post-dilatation was performed for significant aortic regurgitation after TAVI in 11 of 110 patients. When compared to controls, the patients who required balloon post-dilatation had higher aortic leaflet calcium on contrast CT (p<0.01), higher aortic annulus diameters (p<0.01) and higher annulus to prosthesis area ratio (p=0.01). ROC curves demonstrated that aortic root or aortic leaflet calcium measured on either contrastor- non-contrast MSCT showed excellent discrimination for the requirement of balloon post-dilatation (area under ROC >0.80 for all), whereas the discriminatory value of aortic annulus dimensions was moderate (area under ROC=0.69) and that of prosthesis to annulus ratio was poor (area under ROC=0.36).
Conclusions: Dense aortic leaflet calcification measured on contrast MSCT discerned well the need for balloon post-dilatation after TAVI with an MCS for significant PAR. Non-contrast MSCT may no longer be needed to quantify aortic root calcium before TAVI.

• 出版日期2011-9