Associazione Nazionale Medici Cardiologi Ospedalieri



Cct’s Crystal Ball: Predicting Cardiovascular Risk In Aortic Valve Stenosis Patients Undergoing Valve Replacement.

Savo Maria Teresa Padova(Padova) – Azienda Ospedale Università Padova | Pergola Valeria Padova(PD) – Azienda Ospedale Università Padova | Bariani Riccardo Padova(PD) – Azienda Ospedale Università Padova

Background and Aims: Currently, computed tomography cardiac imaging (CTCI) plays a fundamental role in the pre-procedural planning of degenerative-calcific aortic valve stenosis(AS) correction. However, its prognostic role in assessing mortality and major adverse cardiovascular events (MACE) has not been extensively explored. CTCI allows for the evaluation of coronary artery calcification(CAC), mitral annular calcifications (MAC), aortic valve calcifications (CVA), and thoracic aorta calcifications (CAT). The aim of our study was to assess whether the presence and extent of CAC, MAC, CVA, and CAT could influence non-cardiovascular mortality (NCM), cardiovascular mortality (CM), and MACE in patients undergoing valve replacement(VR).

Materials and Methods: We collected retrospectivelly clinical and instrumental data and reviewed CTCI using a semi-quantitative approach. CACs were classified according to the visual 2022 Coronary Artery Disease-Reporting and Data System. MACs were defined following the Guerrero et al. study, CVAs according to the Win Registry and CATs were assessed in the ascending aorta, aortic arch, and descending aorta according to the Vos classification.

Results: 244 patients(59% male, mean age 80.1±6.6 years), with 91% undergoing transfemoral VR, were enrolled(2016-2018). CM was significantly higher in patients with hypertension,cerebro/peripheral vascular disease, stage IV-V renal insufficiency and history of atrial fibrillation (p=0.012,0.001,p=0.005, p=0.034and p=0.024, respectively). CM was also more pronounced in patients with STS SCORE≥6.7±5.2 and EuroSCOREII≥ 5.5±5.8(p=0.016 and p=0.037). Extensive CAC(p=0.019), a MAC score>7(p=0.051), moderate and severe AVC (p=0.029 and p=0.053) and TAC>270° in aortic arch(p=0.019) were linked to CM. In multivariate analysis, a high MAC score and the presence of moderate AVC persisted as risk factors for CM. The presence of a MAC score >7(p=0.006) and the extension of descending TAC >1.5 mm (p=0.034) were associated with an increased risk of NCM.The presence of extensive TAC (≥270°) measured in the aortic arch and descending aorta were associated with MACE (p=0.034 and p=0.0504 respectively).

Conclusions: CTCI emerges as a crucial tool for evaluating prognostic risk in patients undergoing VR for AS. This type of evaluation can assist clinicians in pre-procedural planning and patient management, allowing for better identification of high-risk patients and optimization of therapeutic strategies