G. Guimbretiere, T. Senage, A.S. Boureau, N. Piriou, K. Warin-Fresse, J.M. Serfaty, J.C. Roussel, T. Le Tourneau
{"title":"外科生物瓣膜的主动脉瓣钙化及其对临床结果的影响","authors":"G. Guimbretiere, T. Senage, A.S. Boureau, N. Piriou, K. Warin-Fresse, J.M. Serfaty, J.C. Roussel, T. Le Tourneau","doi":"10.1016/j.acvdsp.2023.04.005","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p><span>Aortic valve calcification (AVC) of surgical valve bioprostheses (BP) has been poorly explored. We aimed to evaluate </span><em>in vivo</em> and <span><em>ex vivo</em></span> BP AVC and its prognosis value.</p></div><div><h3>Method</h3><p>Between 2011 and 2019, AVC was assessed in 361 patients with surgical BP on <em>in vivo</em><span> computed tomography (CT) scanner (6.4</span> <!-->±<!--> <!-->4.3 years after surgery). Follow-up was obtained in all patients. <em>Ex vivo</em> CT-scans were performed in 37 explanted BP.</p></div><div><h3>Results</h3><p>After exclusion of 19 (5.2%) CT-scans, mean <em>in vivo</em> AVC was 307<!--> <!-->±<!--> <!-->500 AU in the remaining 342 BP (77<!--> <!-->±<!--> <!-->9 years, 64% male). Of these, 183 (53.5%) had a structural valve degeneration (SVD) with an AVC of 562<!--> <!-->±<!--> <!-->570 AU compared with 13<!--> <!-->±<!--> <!-->43 AU (<em>P</em> <!--><<!--> <!-->0.0001) for non-SVD BP. Early calcification was observed in around 10% of BP (12/124) examined before the 3rd postoperative year. In explanted BP <em>in vivo</em> AVC correlated strongly with <em>ex vivo</em> AVC (<em>r</em> <!-->=<!--> <!-->0.88, <em>P</em> <!--><<!--> <!-->0.0001). An <em>in vivo</em> AVC<!--> <!-->><!--> <!-->100 AU (<em>n</em> <!-->=<!--> <!-->147, 43%) had an excellent specificity (96%) for diagnosing stage 2–3 SVD. Patients with AVC<!--> <!-->><!--> <!-->100 AU had worse survival compared with those with an AVC<!--> <!--><<!--> <!-->100 (<em>n</em> <!-->=<!--> <!-->195, 57%). In multivariable analyses, AVC value was a predictor of overall mortality (HR<!--> <!-->=<!--> <!-->1.16 [1.04–1.29]; <em>P</em> <!-->=<!--> <span>0.009), cardiovascular mortality (HR</span> <!-->=<!--> <!-->1.21 [1.03–1.41]; <em>P</em> <!-->=<!--> <!-->0.021) and cardiovascular events (HR<!--> <!-->=<!--> <!-->1.19 [1.08–1.31]; <em>P</em> <!-->=<!--> <!-->0.001). After further adjustment for SVD diagnosis, AVC remained a predictor of overall mortality (HR<!--> <!-->=<!--> <!-->1.24 [1.07–1.44]; <em>P</em> <!-->=<!--> <!-->0.005), and cardiovascular events (HR<!--> <!-->=<!--> <!-->1.16 [1.02–1.32]; <em>P</em> <!-->=<!--> <!-->0.029).</p></div><div><h3>Conclusion</h3><p>CT-scan AVC of surgical BP is a reliable tool for assessing leaflets calcification. Whereas calcification can develop early after surgery, an AVC > 100 AU is tightly associated with SVD, and is a strong predictor of overall mortality and cardiovascular events, even after adjustment for SVD diagnosis. Hence, AVC scoring is a complementary tool to echocardiography that should be used in the follow-up of patients with surgical aortic BP.</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":"15 3","pages":"Pages 244-245"},"PeriodicalIF":18.0000,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Aortic valve calcification of surgical bioprostheses and its impact on clinical outcome\",\"authors\":\"G. Guimbretiere, T. Senage, A.S. Boureau, N. Piriou, K. Warin-Fresse, J.M. Serfaty, J.C. Roussel, T. Le Tourneau\",\"doi\":\"10.1016/j.acvdsp.2023.04.005\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p><span>Aortic valve calcification (AVC) of surgical valve bioprostheses (BP) has been poorly explored. We aimed to evaluate </span><em>in vivo</em> and <span><em>ex vivo</em></span> BP AVC and its prognosis value.</p></div><div><h3>Method</h3><p>Between 2011 and 2019, AVC was assessed in 361 patients with surgical BP on <em>in vivo</em><span> computed tomography (CT) scanner (6.4</span> <!-->±<!--> <!-->4.3 years after surgery). Follow-up was obtained in all patients. <em>Ex vivo</em> CT-scans were performed in 37 explanted BP.</p></div><div><h3>Results</h3><p>After exclusion of 19 (5.2%) CT-scans, mean <em>in vivo</em> AVC was 307<!--> <!-->±<!--> <!-->500 AU in the remaining 342 BP (77<!--> <!-->±<!--> <!-->9 years, 64% male). Of these, 183 (53.5%) had a structural valve degeneration (SVD) with an AVC of 562<!--> <!-->±<!--> <!-->570 AU compared with 13<!--> <!-->±<!--> <!-->43 AU (<em>P</em> <!--><<!--> <!-->0.0001) for non-SVD BP. Early calcification was observed in around 10% of BP (12/124) examined before the 3rd postoperative year. In explanted BP <em>in vivo</em> AVC correlated strongly with <em>ex vivo</em> AVC (<em>r</em> <!-->=<!--> <!-->0.88, <em>P</em> <!--><<!--> <!-->0.0001). An <em>in vivo</em> AVC<!--> <!-->><!--> <!-->100 AU (<em>n</em> <!-->=<!--> <!-->147, 43%) had an excellent specificity (96%) for diagnosing stage 2–3 SVD. Patients with AVC<!--> <!-->><!--> <!-->100 AU had worse survival compared with those with an AVC<!--> <!--><<!--> <!-->100 (<em>n</em> <!-->=<!--> <!-->195, 57%). In multivariable analyses, AVC value was a predictor of overall mortality (HR<!--> <!-->=<!--> <!-->1.16 [1.04–1.29]; <em>P</em> <!-->=<!--> <span>0.009), cardiovascular mortality (HR</span> <!-->=<!--> <!-->1.21 [1.03–1.41]; <em>P</em> <!-->=<!--> <!-->0.021) and cardiovascular events (HR<!--> <!-->=<!--> <!-->1.19 [1.08–1.31]; <em>P</em> <!-->=<!--> <!-->0.001). After further adjustment for SVD diagnosis, AVC remained a predictor of overall mortality (HR<!--> <!-->=<!--> <!-->1.24 [1.07–1.44]; <em>P</em> <!-->=<!--> <!-->0.005), and cardiovascular events (HR<!--> <!-->=<!--> <!-->1.16 [1.02–1.32]; <em>P</em> <!-->=<!--> <!-->0.029).</p></div><div><h3>Conclusion</h3><p>CT-scan AVC of surgical BP is a reliable tool for assessing leaflets calcification. Whereas calcification can develop early after surgery, an AVC > 100 AU is tightly associated with SVD, and is a strong predictor of overall mortality and cardiovascular events, even after adjustment for SVD diagnosis. Hence, AVC scoring is a complementary tool to echocardiography that should be used in the follow-up of patients with surgical aortic BP.</p></div>\",\"PeriodicalId\":8140,\"journal\":{\"name\":\"Archives of Cardiovascular Diseases Supplements\",\"volume\":\"15 3\",\"pages\":\"Pages 244-245\"},\"PeriodicalIF\":18.0000,\"publicationDate\":\"2023-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Archives of Cardiovascular Diseases Supplements\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1878648023001441\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of Cardiovascular Diseases Supplements","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1878648023001441","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
Aortic valve calcification of surgical bioprostheses and its impact on clinical outcome
Introduction
Aortic valve calcification (AVC) of surgical valve bioprostheses (BP) has been poorly explored. We aimed to evaluate in vivo and ex vivo BP AVC and its prognosis value.
Method
Between 2011 and 2019, AVC was assessed in 361 patients with surgical BP on in vivo computed tomography (CT) scanner (6.4 ± 4.3 years after surgery). Follow-up was obtained in all patients. Ex vivo CT-scans were performed in 37 explanted BP.
Results
After exclusion of 19 (5.2%) CT-scans, mean in vivo AVC was 307 ± 500 AU in the remaining 342 BP (77 ± 9 years, 64% male). Of these, 183 (53.5%) had a structural valve degeneration (SVD) with an AVC of 562 ± 570 AU compared with 13 ± 43 AU (P < 0.0001) for non-SVD BP. Early calcification was observed in around 10% of BP (12/124) examined before the 3rd postoperative year. In explanted BP in vivo AVC correlated strongly with ex vivo AVC (r = 0.88, P < 0.0001). An in vivo AVC > 100 AU (n = 147, 43%) had an excellent specificity (96%) for diagnosing stage 2–3 SVD. Patients with AVC > 100 AU had worse survival compared with those with an AVC < 100 (n = 195, 57%). In multivariable analyses, AVC value was a predictor of overall mortality (HR = 1.16 [1.04–1.29]; P = 0.009), cardiovascular mortality (HR = 1.21 [1.03–1.41]; P = 0.021) and cardiovascular events (HR = 1.19 [1.08–1.31]; P = 0.001). After further adjustment for SVD diagnosis, AVC remained a predictor of overall mortality (HR = 1.24 [1.07–1.44]; P = 0.005), and cardiovascular events (HR = 1.16 [1.02–1.32]; P = 0.029).
Conclusion
CT-scan AVC of surgical BP is a reliable tool for assessing leaflets calcification. Whereas calcification can develop early after surgery, an AVC > 100 AU is tightly associated with SVD, and is a strong predictor of overall mortality and cardiovascular events, even after adjustment for SVD diagnosis. Hence, AVC scoring is a complementary tool to echocardiography that should be used in the follow-up of patients with surgical aortic BP.
期刊介绍：
Archives of Cardiovascular Diseases Supplements is the official journal of the French Society of Cardiology. The journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles, editorials, and Images in cardiovascular medicine. The topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Additionally, Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.
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