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Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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Aortic valve calcium score pre-TAVI: is 3mensio® software an alternative to the Agatston score?
Session:
Painel 10-Doença Valvular 2
Speaker:
Pedro Morais
Congress:
CPC 2020
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.7 Valvular Heart Disease - Other
Session Type:
Posters
FP Number:
---
Authors:
Pedro Morais; P. Carrilho Ferreira; Joana Rigueira; Rafael Santos; Pedro Silvério António; Sara Couto Pereira; Tiago Graça Rodrigues; João Pedro Ribeiro Agostinho; Beatriz Silva; Joana Brito; Inês Aguiar Ricardo; Fausto José Pinto; Pedro Canas Da Silva; Ana Rita G. Francisco
Abstract
<p><strong>Background</strong>: CTangio(CTA) is currently the recommended method for planning transcatheter aortic valve implantation (TAVI). Calcium (Ca) score seems to be associated with the severity of valvular disease and may be an important predictor of complications, as peri-prosthetic leak. Currently there are softwares that allow quantification of Ca in the valve using CT with and without contrast.</p> <p> </p> <p><strong>Purpose</strong>: to compare two methods of Ca quantification in the aortic valve (3mensio Valves® and Agatston’s score) and to evaluate its relation with the severity of valvular disease and the prognosis.</p> <p> </p> <p><strong>Methods</strong>: Retrospective, single-center study, that evaluates CTA from patients(pts) submitted to TAVI between October 2017-October 2018, with Ca quantification by the 2 methods. Demographic, clinical, echocardiographic, and procedure-related data were collected. The correlation between the 2 forms of Ca measurement with the echocardiographic measurements of aortic stenosis quantification was done with correlation tests (Pearson).</p> <p>The existence of an association between these scores and the occurrence of events or complications was performed using T-student and chi-square tests (X2).</p> <p> </p> <p><strong>Results</strong>: 112 consecutive pts (55.4% women, 81±6.8 years) were included. Most of pts had severe aortic stenosis (95.5%), 2.8% had prosthesis dysfunction and 1.8% had aortic insufficiency. The mean EuroScore II was 3.91 ± 3% and the STS was 5.7±4.2%. In 43.8% of the pts a CoreValve® was implanted and in 51.8% a Sapien®. After procedure, 1.8% of pts had stroke (only 1 major stroke) and 24.1% required a pacemaker.</p> <p>Only 6.3% pts had significant leaks after the procedure, all of moderate severity. A significant calcification of the valves was observed, with a mean Ca score calculated by the Agatston’s method of 3140±1489HU and 892±592mm3 by the 3mensio®. There was a strong correlation between the two forms of quantification (r = 0.769 p <0.001). Ca quantification performed by the 3mensio® software correlated with the mean gradient (r = 0.25 p = 0.015) and the indexed AVA (r = -0.35 p = 0.015).</p> <p>Ca quantification by the Agatston score and 3mensio® were associated with mortality (p = 0.034 and p = 0.001, respectively), but were not independent predictors. None of the scores were associated with other complications.</p> <p> </p> <p><strong>Conclusion</strong>: the amount of Ca in the aortic valve by 3mensio Valves® software shows a strong correlation with the conventional method using the Agatston’s score, both associated to mortality. There was also a correlation between the quantification of the Ca volume by the 3mensio® and the severity of the aortic stenosis. With the future likelihood of performing TAVI in patients at lower risk, reduction of radiation dose in imaging methods is critical. This study suggests that 3mensio® can be used alternatively to the Agatston’s score, allowing the quantification of Ca in CT with contrast, reducing the dose of radiation.</p>
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