Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 May 12;1(4):100349.
doi: 10.1016/j.jscai.2022.100349. eCollection 2022 Jul-Aug.

Aortic Valve Calcium Score Is Associated With Acute Stroke in Transcatheter Aortic Valve Replacement Patients

Michael Foley  1   2 , Kerry Hall  2 , James P Howard  1   2 , Yousif Ahmad  3 , Manisha Gandhi  1   2 , Samir Mahboobani  2 , Joseph Okafor  2 , Haseeb Rahman  2 , Nearchos Hadjiloizou  2 , Neil Ruparelia  2 , Ghada Mikhail  2 , Iqbal Malik  2 , Gajen Kanaganayagam  2 , Nilesh Sutaria  2 , Bushra Rana  2 , Ben Ariff  2 , Edward Barden  2 , Jonathan Anderson  2 , Jonathan Afoke  2 , Ricardo Petraco  2 , Rasha Al-Lamee  1   2 , Sayan Sen  1   2
Affiliations

Aortic Valve Calcium Score Is Associated With Acute Stroke in Transcatheter Aortic Valve Replacement Patients

Michael Foley et al. J Soc Cardiovasc Angiogr Interv. .

Abstract

Background: Transcatheter aortic valve replacement (TAVR) is the treatment of choice for patients with severe aortic stenosis who are at a moderate or higher surgical risk. Stroke is a recognised and serious complication of TAVR, and it is important to identify patients at higher stroke risk. This study aims to discover if aortic valve calcium score calculated from pre-TAVR computed tomography is associated with acute stroke in TAVR patients.

Methods: We conducted a retrospective, observational cohort study of 433 consecutive patients undergoing TAVR between January 2017 and December 2019 at the Hammersmith Hospital.

Results: This cohort had a median age of 83 years (interquartile range, 78-87), and 52.7% were male. Fifty-two patients (12.0%) had a history of previous stroke or transient ischemic attack. Median aortic valve calcium score was 2145 (interquartile range, 1427-3247) Agatston units. Twenty-two patients had a stroke up to the time of discharge (5.1%). In a logistic regression model, aortic valve calcium score was significantly associated with acute stroke (odds ratio [OR], 1.26; 95% confidence interval [CI], 1.01-1.53; P = .02). Acute stroke was also significantly associated with peripheral arterial disease (OR, 4.32; 95% CI, 1.65-10.65; P = .0018) and a longer procedure time (OR, 1.01; 95% CI, 1.00-1.02; P = .0006).

Conclusions: Aortic valve calcium score from pre-TAVR computed tomography is an independent risk factor for acute stroke in the TAVR population. This is an additional clinical value of the pre-TAVR aortic valve calcium score and should be considered when discussing periprocedural stroke risk.

Keywords: AF, atrial fibrillation; AU, Agatston units; Aortic stenosis; CEPD, cerebral embolic protection device; CT, computed tomography; IQR, interquartile range; LVOT, left ventricular outflow tract; PAD, peripheral arterial disease; SAVR, surgical aortic valve replacement; TAVR, transcatheter aortic valve replacement; aortic valve calcium score; computed tomography; stroke; transcatheter aortic valve replacement.

PubMed Disclaimer

Conflict of interest statement

Dr Foley and Dr Al-Lamee report a relationship with Menarini International Pharmaceutics that includes speaking and lecture fees. Dr Al-Lamee, Dr Sen, Dr Petraco, and Dr Foley report a relationship with Philips Healthcare that includes speaking and lecture fees. Dr Rana reports a relationship with Occlutech GmbH and Holistick Medical that includes consulting or advisory and speaking and lecture fees. All other authors report no conflicts to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
An example 3-mm axial slice from a calcium score sequence of the pre-TAVR CT from a patient in the cohort. CT, computed tomography; TAVR, transcatheter aortic valve replacement.
Figure 2
Figure 2
The distribution of aortic valve calcium score in the transcatheter aortic valve replacement cohort. The dashed line represents the study median.
Figure 3
Figure 3
Logistic regression analysis showing the association of CT aortic valve calcium score and probability of stroke. The gray area represents the 95% confidence interval. CT, computed tomography.
Central Illustration
Central Illustration
In this cohort of 433 patients, the aortic valve calcium score from the preprocedural cardiac CT was significantly associated with acute stroke after TAVR (P = .02). CT, computed tomography; TAVR, transcatheter aortic valve replacement.
See this image and copyright information in PMC

References

    1. Vahanian A., Beyersdorf F., Praz F., et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease: developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Eur Heart J. 2022;43(7):561–632. - PubMed
    1. Mack M.J., Leon M.B., Thourani V.H., et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med. 2019;380(18):1695–1705. - PubMed
    1. Werner N., Zeymer U., Schneider S., et al. Incidence and clinical impact of stroke complicating transcatheter aortic valve implantation: results from the German TAVIRegistry: stroke complicating TAVI. Catheter Cardiovasc Interv. 2016;88(4):644–653. - PubMed
    1. Vlastra W., Jimenez-Quevedo P., Tchétché D., et al. Predictors, incidence, and outcomes of patients undergoing transfemoral transcatheter aortic valve implantation complicated by stroke: from the CENTER-Collaboration. Circ Cardiovasc Interv. 2019;12(3) - PubMed
    1. Leon M.B., Smith C.R., Mack M.J., et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016;374(17):1609–1620. - PubMed

LinkOut - more resources