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Foley M, Hall K, Howard JP, Ahmad Y, Gandhi M, Mahboobani S, Okafor J, Rahman H, Hadjiloizou N, Ruparelia N, Mikhail G, Malik I, Kanaganayagam G, Sutaria N, Rana B, Ariff B, Barden E, Anderson J, Afoke J, Petraco R, Al-Lamee R, Sen S. Aortic Valve Calcium Score Is Associated With Acute Stroke in Transcatheter Aortic Valve Replacement Patients. J Soc Cardiovasc Angiogr Interv 2022; 1:100349. [PMID: 35992189 PMCID: PMC9337994 DOI: 10.1016/j.jscai.2022.100349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/04/2022] [Accepted: 04/18/2022] [Indexed: 01/09/2023]
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.
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Affiliation(s)
- Michael Foley
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Kerry Hall
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - James P. Howard
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Yousif Ahmad
- Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Manisha Gandhi
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Samir Mahboobani
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Joseph Okafor
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Haseeb Rahman
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nearchos Hadjiloizou
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Neil Ruparelia
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ghada Mikhail
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Iqbal Malik
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Gajen Kanaganayagam
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nilesh Sutaria
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Bushra Rana
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ben Ariff
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Edward Barden
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Jonathan Anderson
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Jonathan Afoke
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ricardo Petraco
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Rasha Al-Lamee
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Sayan Sen
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
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