Bothaina Mohammed Abdulshakour, Presenter: Nothing to Disclose

Sophie Tan, Abstract Co-Author: Nothing to Disclose

aileen mae bathan lomarda MD, Abstract Co-Author: Nothing to Disclose

Foong Koon Cheah MBChB, FRCR, Abstract Co-Author: Nothing to Disclose

Swee Yaw Tan MBBCh, MRCP, Abstract Co-Author: Nothing to Disclose

In recent years, for patients with severe and symptomatic aortic stenosis, but are not suitable candidates for surgery, Transcatheter Aortic Valve Implantation (TAVI) has been recommended as a less invasive alternative to surgical aortic valve replacement (AVR). However, post-procedural paravalvular aortic regurgitation (PAR) is a common complication that can arise due to incomplete annular sealing or technical errors in valve sizing or positioning. PAR has been associated with an increase in long-term mortality post-TAVI.We would like to determine if the density distribution of calcium in the aortic valves and surrounding walls, as derived from a non-contrast CT, can predict if the patient is likely to have PAR post-TAVI

A total of 29 patients (12 men and 17 women; 77.2 ± 9.69 years) with severe or critical aortic stenosis by echocardiography had TAVI. They had pre-procedural assessment by non-enhanced 320 slice MDCT. The Aortic Valve Calcium (AVC) score was derived measuring the amount of calcium in the aortic valve and immediate surrounding aortic wall calculated using the Agatston schema on a Vitrea workstation. All cases are reviewed independently by a senior cardiologist and a radiologist, with final readings averaged. The degree of post-TAVI PAR was assessed using an invasive aortogram immediately after valve deployment

Elevated AVC scores have a positive correlation with increasing possibility of PAR with an ROC of 0.82 (95%CI: 0.66, 0.97). Optimal corresponding sum of sensitivity and specificity to determine any grade of post TAVI paravalvular leak was an AVC score of 3000. 7 patients out of 29 had no PAR after implantation of the valve. None of these 7 patients had a AVC greater than 3000. All patients with a AVC score of 3000 and above had at least mild paravalvular leak. A cut off point of  >3000 yielded a sensitivity of 0.68 and a specificity of 1.0. With a prevalence of 0.24, the PPV was 1.0 and the NPV was 0.9.

A high AVC score of more than 3000 predict moderate to severe PAR as complication of post TAVI procedure. Therefore, pre-operative scoring of aortic valve calcification by non- enhanced MDCT is highly recommended as predictor of PAR severity post TAVI procedure in which may support decision making for traditional surgical replacement of aortic valve.

AVC can be determined using noncontrast CT and correlates with post TAVI PAR

Abdulshakour, B, Tan, S, lomarda, a, Cheah, F, Tan, S, Correlation of Aortic Valve Calcium Score with Post-Transcatheter Aortic Valve Implantation Paravalvular Aortic Regurgitation.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14012602.html