Aortic Valve Calcium Score Spectrum Identifies Bimodal Outcomes for Transcatheter Aortic Valve Implantation: Insights From the AMTRAC Registry
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 char...
| Autores: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2026 |
| País: | España |
| Institución: | Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau) |
| Repositorio: | r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau |
| OAI Identifier: | oai:dnet:r-iibsantpa_::d68beb97b0563eca2b5fb7528249be72 |
| Acceso en línea: | https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=21476 |
| Access Level: | acceso abierto |
| Palabra clave: | aortic stenosis aortic valve calcium score paravalvular leak transcatheter aortic valve implantation |
| Sumario: | 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. |
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