Prognostic impact of valvular calcification versus vascular calcification in patients with severe aortic stenosis

Abstract Background Calcification of both the aortic valve and the aorta are prognostic markers in patients with aortic valve stenosis (AS). Whether the prognostic impact of valvular calcification persists after successful transcatheter aortic valve implantation (TAVI) is still a matter of debate. Objectives Defining long-term risk groups after TAVI by assessment of calcification load of the aortic valve and the infrarenal aorta. Methods In this retrospective analysis, we analysed the association between contrast enhanced calculated aortic valve Agatston Score Units (cAU) and infrarenal aortic calcification volume as assessed by computed tomography angiography (CTA) with long-term mortality of at least 30 days after TAVI. Results We investigated 1262 patients (age 82.6±5.5 years, 59% female) who underwent TAVI between January 2012 and December 2017. During a follow-up of 3.26 years (IQR 2.01-5.02), patients with lower as well as higher aortic valve calcification (1700cAU) showed a higher risk of mortality in spline function analysis. This higher-risk group showed an increased risk of mortality in univariable (HR1.428 (CI1.061;1.921, P=0.019) and both multivariable Cox regression models (HR1.372 (CI1.007;1.871, P=0.045 and 1.447 (CI 1.065;1.966, P= 0.018), respectively). Infrarenal aortic calcification as dichotomized variable by the median of 1723mm³ was associated with mortality in univariable (HR1.367 (CI1.152;1.622), P