Aortic bioprosthetic leaflet calcification tied to haemodynamic valve deterioration, death risk

18 Oct 2020

Bioprosthetic aortic valve leaflet calcification shows a robust and independent association with haemodynamic valve deterioration (HVD) and the risk of death or aortic valve reintervention (AVR), suggests a study. No sex-related difference exists in the link between aortic valve calcification (AVC) density and haemodynamic or clinical outcomes as opposed to native aortic stenosis.

The authors prospectively enrolled 204 patients from 2008 to 2010, with a median of 7.0 years (interquartile range, 5.1–9.2 years) after biological surgical AVR. AVC density was calculated by indexing AVC (measured using the Agatston method) to the cross-sectional area of aortic annulus (measured by echocardiography).

At 3-year follow-up, the authors assessed the presence of HVD (increase in mean gradient [MG] ≥10 mm Hg and/or increase in transprosthetic regurgitation ≥1) by echocardiography in 137 patients. Mortality or AVR was the primary clinical endpoint.

No significant sex-related difference was found in the relationship between bioprosthetic AVC density and MG progression. At 3 years, baseline AVC density was independently associated with HVD. A total of 134 (65.7 percent) deaths (n=100) or valve reintervention (n=47) occurred during follow-up.

Of note, AVC density ≥58 AU/cm2 independently correlated with a higher risk of mortality or AVR (adjusted hazard ratio, 2.23, 95 percent confidence interval, 1.44–3.35; p<0.001).

Stratification of at-risk patients was amplified by the AVC density threshold combined with an MG progression threshold (log-rank; p<0.001). The addition of AVC density threshold to the prediction model including traditional risk factors improved outcome prediction (net classification improvement, 0.25; p=0.04; likelihood ratio test, p<0.001).

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