Severe Aortic Valve Calcification Research Articles

Grading of Aortic Valve Calcification Severity and Risk Stratification in Aortic Stenosis.

Thresholds of aortic valve calcification (AVC) to define hemodynamically moderate aortic stenosis (AS) from mild are lacking. We aimed to establish a novel grading classification of AVC as quantified by computed tomography and determine its prognostic value. This study included 915 patients with at least mild AS (mean age 70±12 years, 30% women) from a multicenter prospective registry. All patients underwent Doppler-echocardiography and noncontrast computed tomography within 3 months. Primary end point was the occurrence of all-cause death. Receiver operating characteristic curves analyses were used to determine the sensitivity and specificity of sex-specific thresholds of AVC to identify hemodynamically moderate AS. Optimal thresholds (ie, with best sensitivity/specificity) of AVC to distinguish moderate (aortic valve area 1.0-1.5 cm2 and mean gradient 20-39 mm Hg) from mild AS (aortic valve area >1.5 cm2 and mean gradient <20 mm Hg) were AVC ≥360 arbitrary units in women and ≥1037 arbitrary units in men. Based on the guidelines' thresholds for severe AS and the new thresholds in our study for moderate AS, 312 (34%) patients had mild, 253 (28%) moderate, and 350 (38%) severe AVC. During a mean follow-up of 5.6±3.9 years, 183 (27%) deaths occurred. In Cox multivariable models, AVC remained associated with an increased risk of death (adjusted hazard ratio per grade increase, 1.94 [95% CI, 1.53-2.56]; P<0.001). A novel grading classification of anatomic AS severity based on sex-specific thresholds of AVC provides significant prognostic value for predicting mortality. These findings support the complementarity of computed tomography-calcium scoring to Doppler-echocardiography to corroborate AS severity and enhance risk stratification in patients with AS.

Association of TyG index with aortic valve calcification in valvular heart disease patients.

In recent years, triglyceride glucose (TyG) index, as a popular metabolic index, has been proposed as an alternative index of insulin resistance, and it has been proved to be associated with many cardiovascular diseases, but the relationship between it and aortic valve calcification is still unknown. A total of 450 aortic valve disease patients were enrolled in this study, including 361 patients with aortic valve calcification (AVC) (calcification group) and 89 patients without (control group). According to the severity of AVC, patients with AVC included severe calcification, moderate calcification and low calcification. The TyG index was calculated based on fasting triglyceride and fasting blood glucose levels. The TyG index in the calcification group was significantly higher than that in the control group (P < .05), and with the increase of the degree of calcification, the TyG index showed an increasing trend. The univariate and multivariate logistic regression analysis showed TyG index has a high predictive value for the presence of AVC (OR (95% CI): 1.743 (1.036-2.933)) and severe AVC (OR (95% CI): 1.608 (1.143-2.262)). In assessing the predictive value of the TyG index distribution width for AVC, with the first quartile as a reference, the last quartile of the TyG index had significant predictive value for the presence of AVC and severe AVC. TyG index was significantly associated with the presence and severity of AVC, suggesting that TyG index may be a valid predictor of AVC.

Prognostic Value of Aortic Valve Calcification in Nonsevere Aortic Stenosis with Preserved Ejection Fraction.

Aortic valve calcification(AVC) is prognostic in patients with aortic stenosis(AS). We assessed the AVC prognostic value in nonsevere AS patients. We conducted a retrospective study of 395 patients with nonsevere AS, LV ejection fraction ≥50%. The Agatston method was used for computed tomography AVC assessment. The log-rank test determined the best AVC cutoffs for survival under medical surveillance: 1185 AU in men and 850 in women, lower than the established-cutoffs for severe AS(2064AU in men and 1274 in women). Patients were divided into three AVC groups based on these cutoffs: low(<1185 AU men and <850 women), sub-severe(1185-2064AU men and 850-1274 women) and severe(>2064AU men and >1274 women). Of 395 patients(mean age 73 ± 12 years, 60.5% men, aortic valve area 1.23 ± 0.30cm2, mean pressure gradient 28 ± 8 mmHg), 218 underwent aortic valve intervention(AVI) and 158 deaths occurred during follow-up, 82 before AVI. Median survival time under medical surveillance was 2.1[0.7-4.9]years. Compared to the low AVC group, both sub-severe and severe AVC groups had higher risk for all-cause death under medical surveillance after comprehensive adjustment including echocardiographic AS severity and coronary artery calcium score(all p ≤ 0.006); while mortality risk was similar between sub-severe and severe AVC groups(all p ≥ 0.2). This mortality risk pattern persisted in the overall survival analysis after adjustment for AVI. AVI was protective of all-cause death in the sub-severe and severe AVC(all p ≤ 0.01), but not in the low AVC groups. Sub-severe AVC is a robust risk-stratification parameter in patients with nonsevere AS and may inform AVI timing.

Relationship Between Clinical Parameters and Histological Features of Epicardial Adipose Tissue and Aortic Valve Calcification Assessed on Computed Tomography.

The relationships of the clinical and biological attributes of epicardial adipose tissue (EAT) with aortic valve calcification (AVC) have not been characterized. We evaluated the relationships of the clinical and histological features of EAT with AVC assessed using computed tomography (CT).Methods and Results: We enrolled 43 patients undergoing cardiac CT examination prior to elective cardiac surgery in whom AVC was identified on CT. EAT volume and density, coronary calcium score (CCS), AVC score (AVCS), and coronary atherosclerosis on CT angiography were evaluated in each patient. During cardiac surgery, 2 EAT samples were obtained for immunohistochemistry. The number of CD68- and CD11c-positive macrophages and osteocalcin-positive cells was counted in 6 random high-power fields of EAT sections. EAT density, but not EAT volume normalized to body surface area, was positively correlated with the number of macrophages and osteocalcin-positive cells in EAT. There was a positive correlation between ln(AVCS), but not ln(CCS+1), and the number of macrophages and osteocalcin-positive cells in EAT. Multivariate analysis revealed significant positive correlations for ln(AVCS) with EAT density (β=0.42; P=0.0072) and the number of CD68-positive macrophages (β=0.57; P=0.0022), CD11c-positive macrophages (β=0.62; P=0.0003), and osteocalcin-positive cells (β=0.52; P=0.0021) in EAT. Inflammation and osteogenesis in EAT, reflected by high CT density, are associated with the severity of AVC representing aortic valve degeneration.

Abstract 2113: Transcatheter Aortic Valve Replacement (TAVR) Complication: Intraoperative Mitral Regurgitation.

Introduction: Transcatheter aortic valve replacement (TAVR) is the preferred treatment for aortic stenosis (AS) in patients with high surgical risk. This case report delves into a rare, significant intra-procedural mitral regurgitation (MR) of TAVR. Case Presentation: A 94-year-old female with severe AS and a STS score of 3.9% underwent TAVR. A recent 2D ECHO revealed severe AS. CT angiogram pre-TAVR exhibited scattered coronary artery calcifications, severe aortic valve calcification, and calcified atherosclerotic plaque. During the procedure, a 26mm CoreValve was deployed appropriately, with no perivalvular leak observed on angiography and transesophageal echocardiography (TEE). However, post-deployment, the patient experienced a sudden drop in blood pressure, and intra-procedural TEE revealed severe MR, not detected in previous studies. Treatment included pressors, non-invasive positive pressure ventilation, and diuretics, resulting in a favorable response. Subsequent TTE on the 4th day showed improvement in MR. A one-year follow-up TTE revealed only trace MR, confirming the normal functioning of the prosthetic valve. Discussion: Acute mitral regurgitation is an uncommon TAVR complication with potential morbidity and mortality. Various studies propose multiple mechanisms, and in this case, we attribute it to intraoperative global hypoperfusion causing transient MR. Hypoperfusion of the papillary muscle disrupted leaflet coaptation, leading to MR, as supported by its resolution with improved blood pressure. Studies have reported different mechanisms for acute MR, including papillary muscle rupture, leaflet perforation, guidewire impingement, and global hypoperfusion, with some indicating a higher incidence in CoreValve compared to other valve types. Conclusion: Given the rarity of acute MR during TAVR and the unclear pathophysiology, there are no established society guidelines for its management. With TAVR becoming routine, further clinical trials are crucial for optimizing treatment, including head-to-head comparisons of valves and procedural techniques, and developing comprehensive management strategies based on the specific mechanisms of this acute complication.

Aortic valve hemodynamic characteristics after the Ozaki procedure according to echocardiography: a multicenter retrospective study

Aim. To evaluate the aortic valve (AV) hemodynamic characteristics after the Ozaki procedure according to echocardiography.Material and methods. The retrospective multicenter study included 277 patients with AV defects who were operated on from January 2017 to June 2022 in five centers in Russia. After the Ozaki procedure, the following endpoints were assessed: immediate echocardiographic results (peak AV gradient, mean AV gradient, AV effective orifice area, aortic regurgitation grade), mid-term clinical (three-year survival rate, three-year freedom from reoperation, three-year freedom from grade ≤2 aortic regurgitation) and echocardiographic results (peak and mean AV gradient, AV effective orifice area, aortic regurgitation grade, AV calcification severity). The median follow-up period was 23 (13-32) months. The mean echocardiography follow-up period was 21±10 months.Results. During the treatment, a decrease in the peak AV gradient was observed from 74±30 mm Hg before surgery up to 12 (8-16) mm Hg one week after surgery, which remained in the mid-term period — 12 (9-15) mm Hg. There was also a decrease in the mean gradient from 40 (27-53) mm Hg before surgery up to 6 (4-8) mm Hg one week after surgery. By the mid-term period, the mean gradient was 6 (4-8) mm Hg. The AV effective orifice area increased from 1 (1-1) cm2 to 2 (2-2) cm2 in the mid-term follow-up period. Three-year survival rate was 90,2%, freedom from reoperation was 95%, freedom from grade ³2 aortic regurgitation was 88%, and no patient had AV calcification.Conclusion. The Ozaki procedure in patients with AV defects has good immediate and mid-term hemodynamic parameters according to echocardiography. However, there remains a need for large randomized controlled trials comparing Ozaki procedure with biological AV replacement.

Abstract P3070: Aortic Valve Calcification Is Accelerated By DNMT3A And TET2 Gene Driver Mutations Associated With Clonal Hematopoiesis

Background: Clonal hematopoiesis (CH) due to DNMT3A or TET2-driver mutations associates with heightened inflammation and a worse prognosis among patients with severe calcific aortic valve stenosis (AS). However, it is unknown what role CH plays in the pathogenesis of AS. AS is the most common age-related heart valve disease, with no medical therapy to halt progression. Methods and Results: Single-cell RNA-sequencing of immune cells of CAVD patients (n=13) with and without the most prevalent CH-mutations (DNMT3A and TET2), having a mean CH-driver gene variant allele frequency was 6.5% for DNMT3A and 17.9% for TET2. Monocytes of patients harboring DNMT3A and TET2 mutations shared 836 upregulated genes, which were associated with glycolytic, pro-inflammatory activation (CXCL10, IL38) along with paracrine pro-calcific factors (Oncostatin M (OSM), S100A9), signifying that CH might be causally involved in AS. Indeed, silencing of TET2 or DNMT3A in macrophages promotes M1-like polarization and increases release of pro-calcific mediators, particularly S100A9 and OSM. To assess whether CH-gene silenced macrophages may stimulate mesenchymal cells to secrete calcium, secreted factors from TET2 or DNMT3A-silenced macrophages were applied mesenchymal cells. Indeed, CH-gene silenced supernatants induced osteoblastic differentiation of mesenchymal cells, evidenced by increased Alizarin red calcium staining and elevated levels of ALP and RUNX2. This CH-mediated enhancement in osteoblastic transformation could be ablated by silencing of OSM. Finally, valves from atheroprone Ldlr-/- mice receiving Tet2-/- bone marrow transplants demonstrated increased total calcified area (p&lt;0.05, 1.49-fold) along with increased numbers of calcification deposits (p&lt;0.05, 2.33-fold) as shown by von Kossa staining, along with enhanced OSM and S100A9 levels. Conclusion: This is the first study to show that somatic CH-driver mutations in monocytes may accelerate AS. Moreover, calcification was ablated via silencing of OSM in CH-gene silenced macrophages. These data suggest Oncostatin M may be a therapeutically promising target in halting the development of AS in patients harboring CH mutations.

Circulating Irisin Level as a Biomarker for Pure Aortic Stenosis and Aortic Valve Calcification

Irisin, a myokine mainly secreted by skeletal and cardiac muscles, is actively involved in cardiovascular diseases. However, whether irisin is associated with aortic stenosis remains unknown. Two hundred ninety-three severe AS patients who underwent transcatheter aortic valve implantation were enrolled and followed-up for 35 months on average. Enzyme-linked immunosorbent assay (ELISA) was applied to measure circulating irisin levels. Patients were divided into two groups based on the median plasma irisin level. We found that high plasma irisin levels were independently associated with pure aortic stenosis (PAS) after adjusting for age, body mass index, history of peripheral vascular disease, and creatinine (OR = 3.015, 95% CI 1.775–5.119, P < 0.001). ROC curve analysis showed a significant predictive value of irisin for PAS (AUC = 0.647, 95% CI 0.583–0.711, P < 0.001). The severity of aortic valve calcification was negatively associated with plasma irisin levels (P < 0.05). In conclusion, irisin is an independent predictor for PAS and is negatively associated with the severity of aortic valve calcification.

Cardiovascular disease in children with homozygous familial hypercholesterolemia

Background and Aims : Homozygous familial hypercholesterolemia (HoFH) is a rare genetic disorder leading to extremely increased LDL-C, resulting in high risk for cardiovascular disease (CVD) in early childhood. Earliest initiation of lipid lowering treatment is required to prevent premature CVD. Therapy consists of fat-reduced diet, lipid-lowering medication (LLM), and additional lipid apheresis (LA) in severe cases. The aim of the study was to evaluate cardiovascular pathology in children with hoFH.Results: All children needed LLM, and four children additional LA with weekly or biweekly intervals starting at the age of 3 to 5 years, due to extremely elevated LDL-C levels, which reduced LDL-C by >60% (Table 1). Three children had increased IMT. After initiation of LA, IMT improved or remained stable. Initially, cCT showed regular cardiac results. Despite LA, after five to six years three children developed mild calcification of the aorta ascendens or the aortic valve. Moreover, one ten-year-old girl developed a severe aortic valve calcification with high-grade stenosis (aortic jet velocity 3.8 m/s), now under consideration for cardiac surgery.Conclusions: We could show that intensive LLM and LA starting at early age seem to prevent rapid coronary atherosclerosis; nevertheless, aortic calcification (including the valve) may occur. Regular screening for CVD in hoFH children is crucial. Background and Aims : Homozygous familial hypercholesterolemia (HoFH) is a rare genetic disorder leading to extremely increased LDL-C, resulting in high risk for cardiovascular disease (CVD) in early childhood. Earliest initiation of lipid lowering treatment is required to prevent premature CVD. Therapy consists of fat-reduced diet, lipid-lowering medication (LLM), and additional lipid apheresis (LA) in severe cases. The aim of the study was to evaluate cardiovascular pathology in children with hoFH. Results: All children needed LLM, and four children additional LA with weekly or biweekly intervals starting at the age of 3 to 5 years, due to extremely elevated LDL-C levels, which reduced LDL-C by >60% (Table 1). Three children had increased IMT. After initiation of LA, IMT improved or remained stable. Initially, cCT showed regular cardiac results. Despite LA, after five to six years three children developed mild calcification of the aorta ascendens or the aortic valve. Moreover, one ten-year-old girl developed a severe aortic valve calcification with high-grade stenosis (aortic jet velocity 3.8 m/s), now under consideration for cardiac surgery. Conclusions: We could show that intensive LLM and LA starting at early age seem to prevent rapid coronary atherosclerosis; nevertheless, aortic calcification (including the valve) may occur. Regular screening for CVD in hoFH children is crucial.

Importance of Non-Newtonian Computational Fluid Modeling on Severely Calcified Aortic Valve Geometries-Insights From Quasi-Steady State Simulations.

The Newtonian model has commonly been used to represent the viscosity of blood in the aorta, despite blood itself being a non-Newtonian fluid. This is justified where shear rates tend to be large. However, we hypothesized that using the Newtonian model to predict the hemodynamics on the aortic valve, particularly in those with severe calcifications, is inaccurate owing to valve leaflet geometry irregularities inducing multiple regions of low shear rates, <100 s-1, where a Newtonian model is invalid. We investigated the utility of three fluid viscosity models via quasi-static simulations: Newtonian, Carreau, and Quemada on a severely calcified aortic heart valve and compared their ability to capture important hemodynamic parameters of wall shear stress (WSS) and the oscillatory shear index (OSI). Our findings indicate that when the shear rates were large enough, >100 s-1, the use of a Newtonian model was justified. However, in spatial regions of relatively low shear rates, <100 s-1, specifically on the inner cusps of the fibrosa side of the valve, WSS calculations under a Newtonian model were found to be noticeably different when compared with their non-Newtonian, Carreau and Quemada counterparts. We hereby conclude that to facilitate more accurate computational flow simulations in severe aortic heart valve calcification, which is subjected to relatively large spatial regions of low shear (<100 s-1), a non-Newtonian model should be applied.

Implication of Lipids in Calcified Aortic Valve Pathogenesis: Why Did Statins Fail?

Calcific Aortic Valve Disease (CAVD) is a fibrocalcific disease. Lipoproteins and oxidized phospholipids play a substantial role in CAVD; the level of Lp(a) has been shown to accelerate the progression of valve calcification. Indeed, oxidized phospholipids carried by Lp(a) into the aortic valve stimulate endothelial dysfunction and promote inflammation. Inflammation and growth factors actively promote the synthesis of the extracellular matrix (ECM) and trigger an osteogenic program. The accumulation of ECM proteins promotes lipid adhesion to valve tissue, which could initiate the osteogenic program in interstitial valve cells. Statin treatment has been shown to have the ability to diminish the death rate in subjects with atherosclerotic impediments by decreasing the serum LDL cholesterol levels. However, the use of HMG-CoA inhibitors (statins) as cholesterol-lowering therapy did not significantly reduce the progression or the severity of aortic valve calcification. However, new clinical trials targeting Lp(a) or PCSK9 are showing promising results in reducing the severity of aortic stenosis. In this review, we discuss the implication of lipids in aortic valve calcification and the current findings on the effect of lipid-lowering therapy in aortic stenosis.

Efficacy and Safety of Postdilation for a Self-Expanding Transcatheter Heart Valve.

Data are lacking regarding the outcomes of balloon postdilation (BPD) for the Acurate neo and neo2 devices. The aim of this study was to assess the impact of BPD in a large, single-center cohort of patients treated with the Acurate platform. For this retrospective analysis, we included all patients with severe aortic stenosis who underwent transfemoral transcatheter aortic valve replacement (TAVR) with the Acurate neo or neo2 prosthesis at our institution. Among 1417 Acurate recipients, BPD was required in 521 cases (36.8%) for relevant paravalvular regurgitation (PVR) (n = 418) and incomplete prosthesis expansion or increased transprosthetic gradients (n = 103). Overall, BPD was successful in 87.9% and led to a significant reduction of more-than-mild PVR from 32.0% to 7.5% (P<.001). In the BPD group, prosthesis-patient mismatch (PPM) was less common. Prosthetic leaflet damage or valve dislodgment due to BPD occurred in 6 cases (1.2%). All other outcomes were similar between groups with and without BPD, including rates of aortic root injury, stroke, acute kidney injury, permanent pacemaker implantation, and all-cause 30-day mortality. Independent predictors of the need for BPD were higher mean transaortic gradients, severe aortic valve calcification, less prosthesis oversizing, and the use of larger prosthesis sizes. For transfemoral TAVR using the Acurate neo/neo2, BPD effectively reduces relevant PVR and decreases the risk of PPM without increasing adverse events. Transcatheter heart valve damage associated with BPD is rare, commonly avoidable, and does not jeopardize the net benefit of BPD.

Double Envelope Through The Aortic Valve: More than Range Ambiguity to Continuous Wave Doppler

A 70-YEAR-OLD MAN (99 kg, 185 cm) presented for aortic valve replacement owing to severe calcific aortic valve stenosis (AS). His AS was diagnosed recently after an investigation for presyncopal symptoms. Transthoracic echocardiogram demonstrated severe AS with peak and mean gradients of 84 and 48 mmHg, respectively. Asymmetric basal hypertrophy with mild left ventricular outflow tract (LVOT) obstruction also were noted. A peak LVOT gradient of 20 mmHg was measured with Valsalva maneuver, and mild mitral regurgitation was observed.

Calcification of the aortic valve as a possible predictor of paraprosthetic regurgitation after transcatheter aortic valve implantation

Introduction. The development of paraprosthetic regurgitation after transcatheter aortic valve implantation (TAVI) in patients with critical aortic stenosis is an actual problem, which predictors are not well understood. One of the main reasons is calcification of the aortic valve, which does not allow the aortic valve prosthesis to fully expand.Objective – to identify a possible relationship between the severity of aortic valve calcification and the degree of paraprosthetic regurgitation after TAVI.Materials and methods. The study included 23 patients with critical symptomatic aortic stenosis and high risk factors for EuroScore II and STS. The single center study is a retrospective analysis of aortic valve calcification measured by preoperative multislice computed tomography. Calcification (calcium index) of the aortic valve was quantified according to the Agatson method. Paraprosthetic regurgitation was evaluated by transthoracic echocardiography according to the ACC/AHA recommendations. The observation period was 12 months. Results. There female patients predominated in the study group (n=15, 65 %). The mean value of the calcium index (CI) of the aortic valve was 5179.7±2334.1 Agatson units. Intraoperatively, half of the patients (n=12, 52 %) after implantation of aortic valve prosthesis had paraprosthetic regurgitation of more than II degree, which required postdilation. The calcium index in this group of patients was significantly higher (6088.3±2274.4, p=0.049). After implantation of an aortal valve prosthesis, paraprosthetic regurgitation of I–II degrees was observed in 16 patients (70 %) with a CI of 5902.1±2191.9, in 7 patients (30 %) with a CI of 3528.7±1537.2 paraprosthetic regurgitation was absent (p=0.021). In the postoperative period (12 months), no lethal outcomes were detected in the study group. Paraprosthetic regurgitation of I–II degrees was detected in 14 patients with a CI of 5676.6±2275, paraprosthetic regurgitation was absent in 9 patients with a CI of 4406.9±2338.3 (p=0.21).Conclusion. Patients with severe calcification of the aortic valve have an increased risk of developing significant paraprosthetic regurgitation and the use of more aggressive intervention techniques.

Participation of transcriptional factor ZBTB16 in the processes of physiological bone tissue formation and in pathological calcification of the aortic valve

Degenerative calcific aortic valve stenosis is the most common type of heart valve disease in the Western world. Patients with severe stenosis are associated with 50 percent chance of mortality within two years in the absence of intervention. Surgical interventions are the only treatment method for severe calcific aortic valve stenosis to date. Pharmacological approaches have so far failed to affect the course of the disease. Thus, there is an urgent need to develop novel treatment strategies that could slow down the progression of the stenosis. ZBTB16 is a zinc finger protein with N-term BTB/POZ domain (protein-protein interaction motif) and 9 zinc finger domains (DNA binding motif) in C-term. There is growing evidence proving the participation of ZBTB16 in skeletal development. ZBTB16 has been shown to play a role in the specification of limb and axial skeleton patterning. Moreover, the expression of ZBTB16 is increased in patients with ectopic bone formation. Nowadays, the evidence supports that the mechanisms that play key roles in the formation of bone tissue are similar to the processes occurring during the development of ectopic ossification of the aortic valve. Thus, it can be assumed that ZBTB16 is heavily involved in osteogenic transformation in the aortic valve. Understanding similarities and differences in the mechanisms that mediate osteogenic differentiation of stem cells during bone formation and pathological ossification of tissues can help to find the ways to control the osteogenic differentiation in the human body. The aim of this review is to summarize data on the role of ZBTB16 and its products in the regulation of differentiation and proliferation of cells involved in osteogenesis and in the development of ectopic calcification of the aortic valve. The study of the dynamic changes of ZBTB16 expression in aortic valve calcification is a new and relevant study field.

Abstract 14296: Agatston Aortic Valve Calcium Score and the Prediction of Transcatheter Aortic Valve Replacement Complications: A Systematic Review and Meta-Analysis

Introduction: Aortic valve calcium score (AVCS) is used to determine aortic stenosis severity, but whether it affects transcatheter aortic valve replacement (TAVR) complications is not well studied. Methods: We conducted a literature search in PubMed using the key words “Aortic valve”, “Calcium score”, “Aortic stenosis”, “Computed tomography”,” Calcification”, “Calcium”, “TAVR”, “TAVI”, “Outcomes”, “Complications” up to December, 31 st , 2020. Several studies assessed the different factors affecting TAVR outcomes, of these, AVCS was usually found to be one of them. Only a few studies investigated the effect of AVCS on TAVR outcomes. We included studies classifying their patient cohort into high and low AVCS. These studies used the Agatston AVCS derived from non-contrast computed tomography (CT) in patients with native aortic valves and they investigated the TAVR outcomes in both groups. Results: Three studies were included in our meta-analysis with a total number of 1839 patients. Our pooled analysis showed a similar risk of 30-day mortality (low AVCS 2% vs high AVCS 2.5%, P=0.63), Permanent pacemaker implantation (low AVCS 13.3 % vs high AVCS 11.9 %, P=0.73), Stroke (low AVCS 2.54% vs high AVCS 2.3%, P=0.69), and Major vascular complications (low AVCS 7.3% vs high AVCS 5.5%, P=0.60). Conclusion: The severity of Aortic valve calcification calculated by the Agatston AVCS had no impact on 30-day mortality, stroke, major vascular complications, or the need for a permanent pacemaker after TAVR is performed.

Analysis of occurrence and treatment of perioperative complete atrioventricular block by transcatheter aortic valve implantation

Objective: To retrospectively analyze the occurrence and treatment of perioperative complete atrioventricular block (CAVB) by transcatheter aortic valve implantation (TAVI). Methods: A total of 65 patients who underwent TAVI via femoral artery in the Heart Center of Henan People's Hospital from October 2017 to May 2021 were enrolled. Perioperative data of patients were recorded. The patients were divided into two groups according to whether complete atrioventricular block was occurred during TAVI: complete atrioventricular block group (Group CAVB) and non-complete atrioventricular block group (Group NCAVB). Multivariate logistic regression model was used to analyze the risk factors of complete atrioventricular block during transcatheter aortic valve implantation. The incidence of perioperative complications were recorded. Results: The patients age was (69.1±7.3) years old. and there were 35 males and 30 femals. There were 15 patients in group CAVB with complete atrioventricular block and 50 patients in group NCAVB. Multivariate analysis showed that preoperative right bundle branch block [OR (95%CI) vs 3.325 (2.132-13.061), P=0.005] and severe aortic valve calcification [OR (95%CI) vs 1.271 (1.052-3.326), P=0.030] were independent correlative factors for CAVB during TAVI perioperative period. The implantation rate of permanent pacemaker in group CAVB was 73.3% (11 cases), which was higher than 6.0% (3 cases) in group NCAVB (P<0.001). Conclusions: It indicated that preoperative right bundle branch block and severe aortic valve calcification are correlative factors for complete atrioventricular block for TAVI. The implantation rate of permanent pacemaker in complete atrioventricular block group increased significantly.

Rapid pacing is an independent predictor for high implantation depth using self-expandable devices in TAVR

Abstract Background/Introduction Optimizing valve implantation depth (ID) plays a crucial role in minimizing conduction disturbances and achieving optimal functional integrity. Until now, the impact of intraprocedural fast (FP) or rapid ventricular pacing (RP) on the implantation depth has not been investigated. Purpose Therefore, we aimed to 1) evaluate the impact of different pacing maneuvers on ID, and 2) identify the independent predictors of deep ID. Methods 562 TAVR patients with newer-generation self-expandable devices were retrospectively enrolled and further separated into patients undergoing TAVR under FP (n=331; 58.9%) and RP (n=231; 41.1%). The final ID was analyzed, and the underlying functional, anatomical, and procedural conditions were evaluated by univariate and multivariate analysis. Results The highest ID was reached under RP in severe aortic valve calcification and valve size 26 mm. Multivariate analysis identified left ventricular outflow (LVOT) calcification (OR 0.56 [0.37–0.85], p=0.006*), a bicuspid valve (OR 0.34 [0.11–1.0], p=0.049*), valve size 26 mm (OR 0.47 [0.28–0.81], p=0.006*), and RP (OR 0.57 [0.37–0.87], p=0.010*) as independent and highly preventable predictors for deep valve deployment. Independent risk factors for deep ID were the use of a 34 mm device (OR 1.96 [1.22–3.15], p=0.005*) and mild aortic valve calcification (OR 1.62 [0.01–2.61], p=0.046*). In a model of protective factors, ID was significantly reduced with the number of protective criteria (0–2 criteria: −5.6±2.6 mm vs. 3–5 criteria: −4.5±2.0 mm; p&amp;lt;0.0001*). Conclusion Data from this retrospective analysis indicate that RP is an independent predictor to reach a higher implantation depth using self-expandable devices. Funding Acknowledgement Type of funding sources: None.

Factors associated with a high or low implantation of self-expanding devices in TAVR

ObjectivesOptimizing valve implantation depth (ID) plays a crucial role in minimizing conduction disturbances and achieving optimal functional integrity. Until now, the impact of intraprocedural fast (FP) or rapid ventricular pacing (RP) on the implantation depth has not been investigated. Therefore, we aimed to (1) evaluate the impact of different pacing maneuvers on ID, and (2) identify the independent predictors of deep ID.Methods473 TAVR patients with newer-generation self-expanding devices were retrospectively enrolled and one-to-one propensity-score-matching was performed, resulting in a matching of 189 FP and RP patients in each cohort. The final ID was analyzed, and the underlying functional, anatomical, and procedural conditions were evaluated by univariate and multivariate analysis.ResultsThe highest ID was reached under RP in severe aortic valve calcification and valve size 26 mm. Multivariate analysis identified left ventricular outflow (LVOT) calcification [OR 0.50 (0.31–0.81) p = 0.005*], a “flare” aortic root [OR 0.42 (0.25–0.71), p = 0.001*], and RP (OR 0.49 [0.30–0.79], p = 0.004*) as independent highly preventable predictors of a deep ID. In a model of protective factors, ID was significantly reduced with the number of protective criteria (0–2 criteria: − 5.7 mm ± 2.6 vs. 3–4 criteria − 4.3 mm ± 2.0; p < 0.0001*).ConclusionData from this retrospective analysis indicate that RP is an independent predictor to reach a higher implantation depth using self-expanding devices. Randomized studies should prove for validation compared to fast and non-pacing maneuvers during valve delivery and their impact on implantation depth.Trail registrationClinical Trial registration: NCT01805739.Graphic abstractStudy design: Evaluation of the impact of different pacing maneuvers (fast ventricular pacing—FP vs. rapid ventricular pacing—RP) on implantation depth (ID). After one-to-one-propensity-score-matching, independent protective and risk factors for a very deep ID beneath 6 mm toward the LVOT (< − 6 mm) were identified. Stent frame pictures as a courtesy by Medtronic®. AVC aortic valve calcification.

Cardiac Autonomic Response to Active Standing in Calcific Aortic Valve Stenosis.

Aortic stenosis is a progressive heart valve disorder characterized by calcification of the leaflets. Heart rate variability (HRV) analysis has been proposed for assessing the heart response to autonomic activity, which is documented to be altered in different cardiac diseases. The objective of the study was to evaluate changes of HRV in patients with aortic stenosis by an active standing challenge. Twenty-two volunteers without alterations in the aortic valve (NAV) and twenty-five patients diagnosed with moderate and severe calcific aortic valve stenosis (AVS) participated in this cross-sectional study. Ten minute electrocardiograms were performed in a supine position and in active standing positions afterwards, to obtain temporal, spectral, and scaling HRV indices: mean value of all NN intervals (meanNN), low-frequency (LF) and high-frequency (HF) bands spectral power, and the short-term scaling indices (α1 and αsign1). The AVS group showed higher values of LF, LF/HF and αsign1 compared with the NAV group at supine position. These patients also expressed smaller changes in meanNN, LF, HF, LF/HF, α1, and αsign1 between positions. In conclusion, we confirmed from short-term recordings that patients with moderate and severe calcific AVS have a decreased cardiac parasympathetic supine response and that the dynamic of heart rate fluctuations is modified compared to NAV subjects, but we also evidenced that they manifest reduced autonomic adjustments caused by the active standing challenge.