Pierre Lantelme1, Hélène Eltchaninoff2, Muriel Rabilloud3, Géraud Souteyrand4, Marion Dupré2, Marco Spaziano5, Marc Bonnet6, Clément Becle7, Benjamin Riche3, Eric Durand2, Erik Bouvier8, Jean-Nicolas Dacher9, Pierre-Yves Courand7, Lucie Cassagnes10, Eduardo E Dávila Serrano11, Pascal Motreff4, Loic Boussel12, Thierry Lefèvre8, Brahim Harbaoui7. 1. Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France; University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15 Lyon, France. Electronic address: pierre.lantelme@chu-lyon.fr. 2. Cardiology Service, Rouen-Charles-Nicolle University Hospital Center, National Institute of Health and Medical Research U644, Rouen, France. 3. Hospices Civils de Lyon, Service de Biostatistique et Bioinformatique, F-69003 Lyon, France; Université de Lyon, F-69000 Lyon, France; Université Lyon 1, F-69100 Villeurbanne, France; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, F-69100 Villeurbanne, France. 4. Department of Cardiology, Gabriel Montpied University Hospital Center, Image Science for Interventional Techniques, Cardiovascular Interventional Therapy and Imaging, National Scientific Research Center UMR 6284, University of Auvergne, Clermont-Ferrand, France. 5. Institut Cardiovasculaire Paris Sud, Ramsay-Générale de Santé, France; Department of Cardiology, McGill University Health Center, Montreal, Canada. 6. Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France. 7. Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France; University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15 Lyon, France. 8. Institut Cardiovasculaire Paris Sud, Ramsay-Générale de Santé, France. 9. Radiology Department, Rouen-Charles-Nicolle University Hospital Center Rouen, France. 10. Radiology Department, Gabriel Montpied University Hospital Center, and Institut Pascal, TGI UMR6602 CNRS UCA SIGMA, Faculté de Médecine, Clermont-Ferrand, France. 11. University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15 Lyon, France. 12. University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15 Lyon, France; Radiology Department, Hôpital Croix-Rousse, Hospices Civils de Lyon, Lyon, France.
Abstract
OBJECTIVES: The aim of this study was to develop a new scoring system based on thoracic aortic calcification (TAC) to predict 1-year cardiovascular and all-cause mortality. BACKGROUND: A calcified aorta is often associated with poor prognosis after transcatheter aortic valve replacement (TAVR). A risk score encompassing aortic calcification may be valuable in identifying poor TAVR responders. METHODS: The C4CAPRI (4 Cities for Assessing CAlcification PRognostic Impact) multicenter study included a training cohort (1,425 patients treated using TAVR between 2010 and 2014) and a contemporary test cohort (311 patients treated in 2015). TAC was measured by computed tomography pre-TAVR. CAPRI risk scores were based on the linear predictors of Cox models including TAC in addition to comorbidities and demographic, atherosclerotic disease and cardiac function factors. CAPRI scores were constructed and tested in 2 independent cohorts. RESULTS: Cardiovascular and all-cause mortality at 1 year was 13.0% and 17.9%, respectively, in the training cohort and 8.2% and 11.8% in the test cohort. The inclusion of TAC in the model improved prediction: 1-cm3 increase in TAC was associated with a 6% increase in cardiovascular mortality and a 4% increase in all-cause mortality. The predicted and observed survival probabilities were highly correlated (slopes >0.9 for both cardiovascular and all-cause mortality). The model's predictive power was fair (AUC 68% [95% confidence interval [CI]: 64% to 72%]) for both cardiovascular and all-cause mortality. The model performed similarly in the training and test cohorts. CONCLUSIONS: The CAPRI score, which combines the TAC variable with classical prognostic factors, is predictive of 1-year cardiovascular and all-cause mortality. Its predictive performance was confirmed in an independent contemporary cohort. CAPRI scores are highly relevant to current practice and strengthen the evidence base for decision making in valvular interventions. Its routine use may help prevent futile procedures.
OBJECTIVES: The aim of this study was to develop a new scoring system based on thoracic aortic calcification (TAC) to predict 1-year cardiovascular and all-cause mortality. BACKGROUND: A calcified aorta is often associated with poor prognosis after transcatheter aortic valve replacement (TAVR). A risk score encompassing aortic calcification may be valuable in identifying poor TAVR responders. METHODS: The C4CAPRI (4 Cities for Assessing CAlcification PRognostic Impact) multicenter study included a training cohort (1,425 patients treated using TAVR between 2010 and 2014) and a contemporary test cohort (311 patients treated in 2015). TAC was measured by computed tomography pre-TAVR. CAPRI risk scores were based on the linear predictors of Cox models including TAC in addition to comorbidities and demographic, atherosclerotic disease and cardiac function factors. CAPRI scores were constructed and tested in 2 independent cohorts. RESULTS: Cardiovascular and all-cause mortality at 1 year was 13.0% and 17.9%, respectively, in the training cohort and 8.2% and 11.8% in the test cohort. The inclusion of TAC in the model improved prediction: 1-cm3 increase in TAC was associated with a 6% increase in cardiovascular mortality and a 4% increase in all-cause mortality. The predicted and observed survival probabilities were highly correlated (slopes >0.9 for both cardiovascular and all-cause mortality). The model's predictive power was fair (AUC 68% [95% confidence interval [CI]: 64% to 72%]) for both cardiovascular and all-cause mortality. The model performed similarly in the training and test cohorts. CONCLUSIONS: The CAPRI score, which combines the TAC variable with classical prognostic factors, is predictive of 1-year cardiovascular and all-cause mortality. Its predictive performance was confirmed in an independent contemporary cohort. CAPRI scores are highly relevant to current practice and strengthen the evidence base for decision making in valvular interventions. Its routine use may help prevent futile procedures.
Authors: Ning Zhou; Zhili Ji; Fengjuan Li; Bokang Qiao; Rui Lin; Wenxi Jiang; Yuexin Zhu; Yuwei Lin; Kui Zhang; Shuanglei Li; Bin You; Pei Gao; Ran Dong; Yuan Wang; Jie Du Journal: Front Cardiovasc Med Date: 2022-04-01