Aortic Valve Calcium Score Spectrum Identifies Bimodal Outcomes for Transcatheter Aortic Valve Implantation: Insights From the AMTRAC Registry
Por:
Talmor-Barkan, Y, Barbanti, M, Valvo, R, Costa, G, Grasso, C, De Backer, O, Lulic, D, Rodriguez, F, Olmos, C, Masiero, G, Adamo, M, Arzamendi, D, García-Gómez, M, Baz, JA, Steblovnik, K, Mauri, V, Adam, M, Wienemann, H, Hein, M, Ruile, P, Soh, BWT, Patel, KP, Branca, L, Estévez-Loureiro, R, Amat-Santos, IJ, Mylotte, D, Bunc, M, Tarantini, G, Mullen, MJ, Nombela-Franco, L, Aviv, Y, Kornowski, R, Levi, A, Witberg, G
Publicada:
17 mar 2026
Resumen:
Background Degenerative calcification is the primary mechanism underlying severe aortic stenosis; however, some patients with hemodynamically severe aortic stenosis have low aortic valve calcium scores (AVCS), suggesting heterogeneous disease processes. This study aimed to evaluate the clinical characteristics and outcomes across the spectrum of AVCS. Methods We performed a retrospective analysis of the AMTRAC (Aortic+Mitral Transcatheter Valve) registry, including 3766 patients with severe aortic stenosis who underwent transcatheter aortic valve implantation across 16 centers mainly in Europe (2013-2024). Patients were stratified into three groups of low, high, or very high based on their AVCS. The primary end point was 3-year mortality. Secondary end points included periprocedural outcomes (Valve Academic Research Consortium-3) and posttranscatheter aortic valve implantation hemodynamics. Results Patients with low AVCS more frequently presented with low-gradient aortic stenosis and advanced New York Heart Association classes. At 3 years, mortality displayed a bimodal pattern in association with AVCS spectrum: 30.5% in the low, 26.5% in the high, and 31.3% in the very-high AVCS group (P<0.05). Paravalvular leak greater than moderate increased with AVCS severity (0.5%, 0.9%, 1.9%, for low, high, and very-high AVCS, respectively; P<0.01). The risk for stroke and permanent pacemaker implantation were also higher in the very-high AVCS group compared with the low/high AVCS groups (stroke: 4.1%, 1.4%, 2.4%; permanent pacemaker: 21.2%, 14.7%, 14.2%; for very-high, low, high, respectively; P<0.05 for both). Conclusions Low AVCS defines a unique phenotype marked by predominant fibrosis, advanced symptoms, and increased mortality despite fewer procedural complications. In contrast, very-high AVCS is linked to higher procedural risk, more bicuspid valves, and increased mortality. These insights challenge calcification-based criteria and support incorporating fibrosis assessment into treatment strategies.
Filiaciones:
Talmor-Barkan, Y:
Rabin Med Ctr, Dept Cardiol, Petah Tiqwa, Israel
Tel Aviv Univ, Gray Fac Med & Hlth Sci, Tel Aviv, Israel
Barbanti, M:
Univ Enna Kore, Enna, Italy
Univ Catania, Div Cardiol, Catania, Italy
Valvo, R:
Univ Catania, Div Cardiol, Catania, Italy
Costa, G:
Univ Catania, Div Cardiol, Catania, Italy
Grasso, C:
Univ Catania, Div Cardiol, Catania, Italy
De Backer, O:
Copenhagen Univ Hosp, Rigshosp, Heart Ctr, Copenhagen, Denmark
Lulic, D:
Copenhagen Univ Hosp, Rigshosp, Heart Ctr, Copenhagen, Denmark
Rodriguez, F:
Inst Invest Sanitaria Hosp Clin San Carlos IdISSC, Hosp Clin San Carlos, Inst Cardiovasc, Madrid, Spain
Olmos, C:
Inst Invest Sanitaria Hosp Clin San Carlos IdISSC, Hosp Clin San Carlos, Inst Cardiovasc, Madrid, Spain
Masiero, G:
Univ Padua, Med Sch, Dept Cardiac Thorac & Vasc Sci, Padua, Italy
Adamo, M:
Spedali Civil Brescia, Cardiovasc Dept, Brescia, Italy
Arzamendi, D:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
García-Gómez, M:
Hosp Clin Univ Valladolid, CIBERCV, Valladolid, Spain
Baz, JA:
Hosp Alvaro Cunqueiro, Serv Cardiol, Vigo, Pontevedra, Spain
Steblovnik, K:
Univ Med Ctr, Dept Cardiol, Ljubljana, Slovenia
Mauri, V:
Univ Cologne, Fac Med, Clin Internal Med 3, Cologne, Germany
Univ Cologne, Univ Hosp Cologne, Cologne, Germany
Adam, M:
Univ Cologne, Fac Med, Clin Internal Med 3, Cologne, Germany
Univ Cologne, Univ Hosp Cologne, Cologne, Germany
Wienemann, H:
Univ Cologne, Fac Med, Clin Internal Med 3, Cologne, Germany
Univ Cologne, Univ Hosp Cologne, Cologne, Germany
Hein, M:
Univ Freiburg, Univ Heart Ctr Freiburg Bad Krozingen, Fac Med, Dept Cardiol & Angiol, Freiburg, Germany
Ruile, P:
Univ Freiburg, Univ Heart Ctr Freiburg Bad Krozingen, Fac Med, Dept Cardiol & Angiol, Freiburg, Germany
Soh, BWT:
Galway Univ Hosp, Dept Cardiol, Galway, Ireland
Univ Galway, Galway, Ireland
Patel, KP:
St Bartholomews Hosp, Barts Heart Ctr, London, England
Branca, L:
Spedali Civil Brescia, Cardiovasc Dept, Brescia, Italy
Estévez-Loureiro, R:
Hosp Alvaro Cunqueiro, Serv Cardiol, Vigo, Pontevedra, Spain
Amat-Santos, IJ:
Hosp Clin Univ Valladolid, CIBERCV, Valladolid, Spain
Mylotte, D:
Galway Univ Hosp, Dept Cardiol, Galway, Ireland
Univ Galway, Galway, Ireland
Bunc, M:
Univ Med Ctr, Dept Cardiol, Ljubljana, Slovenia
Tarantini, G:
Univ Padua, Med Sch, Dept Cardiac Thorac & Vasc Sci, Padua, Italy
Mullen, MJ:
St Bartholomews Hosp, Barts Heart Ctr, London, England
Nombela-Franco, L:
Inst Invest Sanitaria Hosp Clin San Carlos IdISSC, Hosp Clin San Carlos, Inst Cardiovasc, Madrid, Spain
Aviv, Y:
Rabin Med Ctr, Dept Cardiol, Petah Tiqwa, Israel
Tel Aviv Univ, Gray Fac Med & Hlth Sci, Tel Aviv, Israel
Kornowski, R:
Rabin Med Ctr, Dept Cardiol, Petah Tiqwa, Israel
Tel Aviv Univ, Gray Fac Med & Hlth Sci, Tel Aviv, Israel
Levi, A:
Rabin Med Ctr, Dept Cardiol, Petah Tiqwa, Israel
Tel Aviv Univ, Gray Fac Med & Hlth Sci, Tel Aviv, Israel
Witberg, G:
Rabin Med Ctr, Dept Cardiol, Petah Tiqwa, Israel
Tel Aviv Univ, Gray Fac Med & Hlth Sci, Tel Aviv, Israel
Green Submitted, gold
|