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Curso de Atualização em Medicina Cardiovascular 2019
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The Vascular Calcium Score: a new tool to quantify vascular calcification and predict bleeding in transfemoral TAVI
Session:
CO1 - Cardiologia de Intervenção
Speaker:
Afonso Félix Oliveira
Congress:
CPC 2019
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Afonso Félix De Oliveira; Rui Campante Teles; António Miguel Ferreira; João Brito; Pedro de Araújo Gonçalves; Luís Raposo ; Henrique Gabriel; Tiago Nolasco; Gonçalo Lopes Da Cunha; João Abecasis; Carla Rodrigues Carvalho; Manuel Almeida; Miguel Mendes
Abstract
<p><strong>Introduction</strong>:</p> <p>Vascular calcification has been associated with worse outcomes in transfemoral TAVI (TF-TAVI). However, there is currently no simple method to assess it and identify different patterns of calcification in an objective and quantitative manner. The purpose of this study was to develop a quantitative score of aortic (Ao) and ileofemural (IF) calcification and to assess its ability to predict life-threatening bleeding (LTB) and major vascular complications during TF-TAVI.</p> <p><strong>Methods</strong>:</p> <p>Case-control single center retrospective study of patients undergoing TF-TAVI between Nov2015 and Aug2018 including 183 consecutive patients (99 women, mean age 83±3 years, mean Euroscore II - ESII - 6.0±4.1). The Vascular Calcium Score was calculated for the entire Ao and IF vessels using a modified Agatston score derived from contrast-enhanced CT images, with calcium threshold locally adjusted for luminal attenuation (mean attenuation + 5x SD). A luminal attenuation threshold >600UH impaired vascular calcium evaluation and patients were excluded. LTB and major vascular complications were adjudicated according to the VARC-2 classification and identified by chart review by and independent team.</p> <p><strong>Results</strong>:. Thirty patients (16%) suffered major bleeding and 13 (7%) experienced LTB. Major vascular injury occurred in 11 patients (6%). The median total vascular calcium score (TCS) was 11752 AU (IQR: 6388-19844) and median IF score (IFS) was 2210AU (IQR: 865–4170). TCS indexed for body surface area (TCSi) was predictor of LTB (AUC: 0.78±0.07, p<0.05) and of major vascular complications (AUC: 0.85±0.05, p<0.05). After multivariate analysis, iTCS and glomerular filtration rate (GFR) remained as predictors of LTB with an HR of 1.11 for each increase in 1000UA/m2 of TCSi (95%CI: 1.03-1.18) and 0.94 (95%CI: 0.88-0.985) respectively, independently of the ESII. iTCS and GFR were also independently associated with major vascular complications (p < 0.05). Patients with an iTCS above 9750AU/m2 have an odds ratio of 7.7 (95%CI: 2.0 - 29.2) for LTB. This cut-off has a sensitivity of 77% and a specificity of 70% for LTB. Similarly, patients with an iTCS above 9750AU/m2 have an odds ratio of 10.3 (95%CI: 22 - 49.3) for major vascular injury.</p> <p><strong>Conclusions</strong>: A quantitative score for vascular calcification in contrast-enhanced CT images was developed. iTCS was independently associated with life-threatening bleeding and major vascular complications.</p>
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