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Association of Thoracic Aorta Calcium Score With Left Ventricular Hypertrophy and Clinical Outcomes in Patients With Severe Aortic Stenosis After Aortic Valve Replacement

Authors
 In-Jeong Cho  ;  Hyuk-Jae Chang  ;  Ran Heo  ;  In-Cheol Kim  ;  Ji Min Sung  ;  Byung-Chul Chang  ;  Chi Young Shim  ;  Geu-Ru Hong  ;  Namsik Chung 
Citation
 ANNALS OF THORACIC SURGERY, Vol.103(1) : 74-82, 2017 
Journal Title
 ANNALS OF THORACIC SURGERY 
ISSN
 0003-4975 
Issue Date
2017
MeSH
Aorta, Thoracic/diagnostic imaging* ; Aorta, Thoracic/metabolism ; Aortic Diseases/complications* ; Aortic Diseases/diagnosis ; Aortic Valve Stenosis/diagnosis* ; Aortic Valve Stenosis/etiology ; Aortic Valve Stenosis/surgery ; Calcinosis/complications ; Calcinosis/diagnosis* ; Calcinosis/metabolism ; Calcium/metabolism ; Echocardiography ; Female ; Follow-Up Studies ; Heart Valve Prosthesis Implantation/adverse effects* ; Humans ; Hypertrophy, Left Ventricular/complications* ; Hypertrophy, Left Ventricular/diagnosis ; Hypertrophy, Left Ventricular/physiopathology ; Male ; Middle Aged ; Postoperative Complications* ; Prognosis ; Retrospective Studies ; Severity of Illness Index ; Time Factors ; Tomography, X-Ray Computed
Abstract
BACKGROUND: Substantial aortic calcification is known to be associated with aortic stiffening and subsequent left ventricular (LV) hypertrophy. This study examined whether the thoracic aorta calcium score (TACS) is related to LV hypertrophy and whether it leads to an adverse prognosis in patients with severe aortic stenosis (AS) after aortic valve replacement (AVR). METHODS: We retrospectively reviewed 47 patients (mean age, 64 ± 11 years) with isolated severe AS who underwent noncontrast computed tomography of the entire thoracic aorta and who received AVR. TACS was quantified using the volume method with values becoming log transformed (log[TACS+1]). Transthoracic echocardiography was performed before and 1 year after the operation. RESULTS: Preoperative LV mass index (LVMI) displayed significant positive correlations with male gender (r = 0.430, p = 0.010) and log(TACS+1) (r = 0.556, p = 0.003). In multivariate linear regression analysis, only log(TACS+1) was independently associated with LVMI, even after adjusting for age, gender, transaortic mean pressure gradient, and coronary or valve calcium score. Independent determinants for postoperative LVMI included log(TACS+1) and preoperative LVMI after 1 year of follow-up echocardiography, adjusting for age, gender, indexed effective orifice area, and coronary or valve calcium score. During a median follow-up period of 54 months after AVR, there were 10 events (21%), which included 4 deaths from all-causes, 3 strokes, 2 inpatient admissions for heart failure, and 1 myocardial infarction. The event-free survival rate was significantly lower for patients with TACS of 2,257 mm3 or higher compared with those whose TACS was lower than 2,257 mm3 (log-rank p < 0.001). CONCLUSIONS: High TACS was associated with increased LVMI among patients with severe AS. Further, high TACS usefully predicted less regression of LVMI and poor clinical outcomes after AVR. TACS may serve as a useful proxy for predicting LV remodeling and adverse prognosis in patients with severe AS undergoing AVR.
Full Text
http://www.sciencedirect.com/science/article/pii/S000349751630532X
DOI
10.1016/j.athoracsur.2016.05.039
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, In Cheol(김인철)
Sung, Ji Min(성지민)
Shim, Chi Young(심지영) ORCID logo https://orcid.org/0000-0002-6136-0136
Chang, Byung Chul(장병철)
Chang, Hyuk-Jae(장혁재) ORCID logo https://orcid.org/0000-0002-6139-7545
Chung, Nam Sik(정남식)
Cho, In Jeong(조인정)
Heo, Ran(허란)
Hong, Geu Ru(홍그루) ORCID logo https://orcid.org/0000-0003-4981-3304
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/153369
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