Details

Autor(en) / Beteiligte

• Flores-Umanzor, Eduardo
• Keshvara, Rajesh
• Reza, Seleman
• Asghar, Areeba
• Rashidul Anwar, Mohammed
• Cepas-Guillen, Pedro L.
• Osten, Mark
• Halankar, Jaydeep
• Abrahamyan, Lusine
• Horlick, Eric

Titel

A systematic review of contrast-enhanced computed tomography calcium scoring methodologies and impact of aortic valve calcium burden on TAVI clinical outcomes

Ist Teil von

• Journal of cardiovascular computed tomography, 2023-11, Vol.17 (6), p.373-383

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2023

Quelle

MEDLINE

Beschreibungen/Notizen

• Different methodologies have been used to assess the role of AV calcification (AVC) on TAVI outcomes. This systematic review aims to describe the burden of AVC, synthesize the different methods of calcium score quantification, and evaluate the impact of AVC on outcomes after TAVI. We included studies of TAVI patients who had reported AV calcium scoring by contrast-enhanced multidetector CT and the Agatston method. The impact of calcification on TAVI outcomes without restrictions on follow-up time or outcome type was evaluated. Results were reported descriptively, and a meta-analysis was conducted when feasible. Sixty-eight articles were included, with sample sizes ranging from 23 to 1425 patients. Contrast-enhanced calcium scoring was reported in 30 studies, calcium volume score in 28 studies, and unique scoring methods in two. All studies with calcium volume scores had variable protocols, but most utilized a modified Agatston method with variable attenuation threshold values of 300–850 HU. Eight studies used the Agatston method, with the overall mean AV calcium score in studies published from 2010 to 2012 of 3342.9 AU [95%CI: 3150.4; 3535.4, I2 ​= ​0%]. The overall mean score was lower and heterogenous in studies published from 2014 to 2020 (2658.9 AU [95% CI: 2517.3; 2800.5, I2 ​= ​79%]. Most studies reported a positive association between calcium burden and increased risk of adverse outcomes, including implantation of permanent pacemaker (7/8 studies), paravalvular leak (13/13 studies), and risk of aortic rupture (2/2 studies). AVC quantification methodology with contrast-enhanced CT is still variable. AVC negatively impacts TAVI outcomes independently of the quantification method. This systematic review examines the role of aortic valve calcification (AVC) on transcatheter aortic valve implantation (TAVI) outcomes. Sixty-eight studies were included, reporting varied methodologies for quantifying AVC. AVC quantification methodology with contrast-enhanced CT was found to be variable. A positive association between calcium burden and increased risk of adverse outcomes, including permanent pacemaker implantation, paravalvular leak, and aortic rupture, was reported. AVC negatively impacts TAVI outcomes independently of the quantification method.