Aortic angle distribution and predictors of horizontal aorta in patients undergoing transcatheter aortic valve replacement
Horizontal aorta (HA) is an anatomical feature that can pose significant technical challenges for the successful positioning of the bioprosthetic valve during transcatheter aortic valve replacement (TAVR). Physiological range of aortic angle (AA) is unknown; hence there is no cutoff AA for classifyi...
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| Veröffentlicht in: | International journal of cardiology 2021-09, Vol.338, p.58-62 |
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| creator | Moscarelli, Marco Gallo, Francesco Gallone, Guglielmo Kim, Won-Keun Reifart, Jörg Veulemans, Verena Zeus, Tobias Toggweiler, Stefan De Backer, Ole Søndergaard, Lars Mangieri, Antonio De Marco, Federico Regazzoli, Damiano Reimers, Bernhard Muntané-Carol, Guillem Lauriero, Rodrigo Estevez Armario, Xavier Mylotte, Darren Bhadra, Oliver Daniel Conradi, Lenard Donday, Luis Alfonso Marroquin Nombela-Franco, Luis Barbanti, Marco Reddavid, Claudia Brugaletta, Salvatore Nicolini, Elisa Tzanis, Giorgos Rodes-Cabau, Josep Colombo, Antonio Giannini, Francesco |
| description | Horizontal aorta (HA) is an anatomical feature that can pose significant technical challenges for the successful positioning of the bioprosthetic valve during transcatheter aortic valve replacement (TAVR). Physiological range of aortic angle (AA) is unknown; hence there is no cutoff AA for classifying HA. Moreover, patient characteristics predicting HA are under-investigated.
This was a retrospective analysis of prospective collected data from 16 heart valve centers in Europe. The study utilized a common dataset with a priori agreed-upon definitions and variables. Eligible patients underwent TAVR between 2014 and 2020 and had multidetector computed tomographic imaging data available for determining the AA. The analysis described the distribution of AA and potential predictors of HA. Inter-center variability was also explored.
For 4022 patients analyzed, the mean AA ± standard deviation was 49.4° ± 9.4° (median 49°, inter-quartile range [IQR] 12°, range 18–90°). There was no significant difference in mean AA between men and women (49.4° ± 9.1° vs. 49.6° ± 9.3°, respectively; p = 0.53); therefore, 49.4° was accepted as the cutoff value for HA in subsequent analyses. Covariates significantly associated with HA included age (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 1.01–1.04, p < 0.001), body mass index (OR: 1.06, 95% CI: 1.05–1.08, p < 0.01), previous cardiac surgery (OR: 0.58, 95% CI: 0.45–0.75, p < 0.001), and porcelain aorta (OR: 0.66, 95% CI: 0.52–0.85, p = 0.001). Some inter-center variability was observed.
We defined 49.4° as the mean AA, and also associated predictors of HA in a large case series of patients with severe aortic stenosis candidates for TAVR.
•What is the physiological aortic angle distribution in TAVR patients?•Mean aortic angle in a large series of TAVR patients with aortic stenosis was 49.4°.•Higher aortic angle values were observed in the elderly and in the obese. |
| doi_str_mv | 10.1016/j.ijcard.2021.05.054 |
| format | Article |
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This was a retrospective analysis of prospective collected data from 16 heart valve centers in Europe. The study utilized a common dataset with a priori agreed-upon definitions and variables. Eligible patients underwent TAVR between 2014 and 2020 and had multidetector computed tomographic imaging data available for determining the AA. The analysis described the distribution of AA and potential predictors of HA. Inter-center variability was also explored.
For 4022 patients analyzed, the mean AA ± standard deviation was 49.4° ± 9.4° (median 49°, inter-quartile range [IQR] 12°, range 18–90°). There was no significant difference in mean AA between men and women (49.4° ± 9.1° vs. 49.6° ± 9.3°, respectively; p = 0.53); therefore, 49.4° was accepted as the cutoff value for HA in subsequent analyses. Covariates significantly associated with HA included age (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 1.01–1.04, p < 0.001), body mass index (OR: 1.06, 95% CI: 1.05–1.08, p < 0.01), previous cardiac surgery (OR: 0.58, 95% CI: 0.45–0.75, p < 0.001), and porcelain aorta (OR: 0.66, 95% CI: 0.52–0.85, p = 0.001). Some inter-center variability was observed.
We defined 49.4° as the mean AA, and also associated predictors of HA in a large case series of patients with severe aortic stenosis candidates for TAVR.
•What is the physiological aortic angle distribution in TAVR patients?•Mean aortic angle in a large series of TAVR patients with aortic stenosis was 49.4°.•Higher aortic angle values were observed in the elderly and in the obese.</description><identifier>ISSN: 0167-5273</identifier><identifier>EISSN: 1874-1754</identifier><identifier>DOI: 10.1016/j.ijcard.2021.05.054</identifier><language>eng</language><publisher>Elsevier B.V</publisher><subject>Aortic angle ; Horizontal aorta ; Obesity paradox ; TAVR ; Transcatheter aortic valve replacement</subject><ispartof>International journal of cardiology, 2021-09, Vol.338, p.58-62</ispartof><rights>2021 Elsevier B.V.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c339t-8be1844018a280cb56aa8ddeac2de11688d85bfe208f67977da60ccbfe542f073</citedby><cites>FETCH-LOGICAL-c339t-8be1844018a280cb56aa8ddeac2de11688d85bfe208f67977da60ccbfe542f073</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ijcard.2021.05.054$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3548,27923,27924,45994</link.rule.ids></links><search><creatorcontrib>Moscarelli, Marco</creatorcontrib><creatorcontrib>Gallo, Francesco</creatorcontrib><creatorcontrib>Gallone, Guglielmo</creatorcontrib><creatorcontrib>Kim, Won-Keun</creatorcontrib><creatorcontrib>Reifart, Jörg</creatorcontrib><creatorcontrib>Veulemans, Verena</creatorcontrib><creatorcontrib>Zeus, Tobias</creatorcontrib><creatorcontrib>Toggweiler, Stefan</creatorcontrib><creatorcontrib>De Backer, Ole</creatorcontrib><creatorcontrib>Søndergaard, Lars</creatorcontrib><creatorcontrib>Mangieri, Antonio</creatorcontrib><creatorcontrib>De Marco, Federico</creatorcontrib><creatorcontrib>Regazzoli, Damiano</creatorcontrib><creatorcontrib>Reimers, Bernhard</creatorcontrib><creatorcontrib>Muntané-Carol, Guillem</creatorcontrib><creatorcontrib>Lauriero, Rodrigo Estevez</creatorcontrib><creatorcontrib>Armario, Xavier</creatorcontrib><creatorcontrib>Mylotte, Darren</creatorcontrib><creatorcontrib>Bhadra, Oliver Daniel</creatorcontrib><creatorcontrib>Conradi, Lenard</creatorcontrib><creatorcontrib>Donday, Luis Alfonso Marroquin</creatorcontrib><creatorcontrib>Nombela-Franco, Luis</creatorcontrib><creatorcontrib>Barbanti, Marco</creatorcontrib><creatorcontrib>Reddavid, Claudia</creatorcontrib><creatorcontrib>Brugaletta, Salvatore</creatorcontrib><creatorcontrib>Nicolini, Elisa</creatorcontrib><creatorcontrib>Tzanis, Giorgos</creatorcontrib><creatorcontrib>Rodes-Cabau, Josep</creatorcontrib><creatorcontrib>Colombo, Antonio</creatorcontrib><creatorcontrib>Giannini, Francesco</creatorcontrib><title>Aortic angle distribution and predictors of horizontal aorta in patients undergoing transcatheter aortic valve replacement</title><title>International journal of cardiology</title><description>Horizontal aorta (HA) is an anatomical feature that can pose significant technical challenges for the successful positioning of the bioprosthetic valve during transcatheter aortic valve replacement (TAVR). Physiological range of aortic angle (AA) is unknown; hence there is no cutoff AA for classifying HA. Moreover, patient characteristics predicting HA are under-investigated.
This was a retrospective analysis of prospective collected data from 16 heart valve centers in Europe. The study utilized a common dataset with a priori agreed-upon definitions and variables. Eligible patients underwent TAVR between 2014 and 2020 and had multidetector computed tomographic imaging data available for determining the AA. The analysis described the distribution of AA and potential predictors of HA. Inter-center variability was also explored.
For 4022 patients analyzed, the mean AA ± standard deviation was 49.4° ± 9.4° (median 49°, inter-quartile range [IQR] 12°, range 18–90°). There was no significant difference in mean AA between men and women (49.4° ± 9.1° vs. 49.6° ± 9.3°, respectively; p = 0.53); therefore, 49.4° was accepted as the cutoff value for HA in subsequent analyses. Covariates significantly associated with HA included age (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 1.01–1.04, p < 0.001), body mass index (OR: 1.06, 95% CI: 1.05–1.08, p < 0.01), previous cardiac surgery (OR: 0.58, 95% CI: 0.45–0.75, p < 0.001), and porcelain aorta (OR: 0.66, 95% CI: 0.52–0.85, p = 0.001). Some inter-center variability was observed.
We defined 49.4° as the mean AA, and also associated predictors of HA in a large case series of patients with severe aortic stenosis candidates for TAVR.
•What is the physiological aortic angle distribution in TAVR patients?•Mean aortic angle in a large series of TAVR patients with aortic stenosis was 49.4°.•Higher aortic angle values were observed in the elderly and in the obese.</description><subject>Aortic angle</subject><subject>Horizontal aorta</subject><subject>Obesity paradox</subject><subject>TAVR</subject><subject>Transcatheter aortic valve replacement</subject><issn>0167-5273</issn><issn>1874-1754</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kEFr3DAQhUVpoNuk_6AHHXPxVrIlW74EQkjTQCCX5CxmpfFGi1dyRtqF5NdXyfZcGBh4vPeG-Rj7KcVaCtn_2q3DzgH5dStauRa6jvrCVtIMqpGDVl_ZqtqGRrdD9419z3knhFDjaFbs_TpRCY5D3M7IfciFwuZQQopV8nwh9MGVRJmnib8kCu8pFpg51BjwEPkCJWAsmR-iR9qmELe8EMTsoLxgQfq01gtHmI_ICZcZHO5r5IKdTTBn_PFvn7Pn37dPN3-ah8e7-5vrh8Z13Vgas0FplBLSQGuE2-gewHiP4FqPUvbGeKM3E7bCTP0wDoOHXjhXFa3aSQzdObs89S6UXg-Yi92H7HCeIWI6ZNvqzghl9GiqVZ2sjlLOhJNdKOyB3qwU9gO13dkTavuB2gpdR9XY1SmG9Y1jQLLZVSiusiN0xfoU_l_wF-7ojWI</recordid><startdate>20210901</startdate><enddate>20210901</enddate><creator>Moscarelli, Marco</creator><creator>Gallo, Francesco</creator><creator>Gallone, Guglielmo</creator><creator>Kim, Won-Keun</creator><creator>Reifart, Jörg</creator><creator>Veulemans, Verena</creator><creator>Zeus, Tobias</creator><creator>Toggweiler, Stefan</creator><creator>De Backer, Ole</creator><creator>Søndergaard, Lars</creator><creator>Mangieri, Antonio</creator><creator>De Marco, Federico</creator><creator>Regazzoli, Damiano</creator><creator>Reimers, Bernhard</creator><creator>Muntané-Carol, Guillem</creator><creator>Lauriero, Rodrigo Estevez</creator><creator>Armario, Xavier</creator><creator>Mylotte, Darren</creator><creator>Bhadra, Oliver Daniel</creator><creator>Conradi, Lenard</creator><creator>Donday, Luis Alfonso Marroquin</creator><creator>Nombela-Franco, Luis</creator><creator>Barbanti, Marco</creator><creator>Reddavid, Claudia</creator><creator>Brugaletta, Salvatore</creator><creator>Nicolini, Elisa</creator><creator>Tzanis, Giorgos</creator><creator>Rodes-Cabau, Josep</creator><creator>Colombo, Antonio</creator><creator>Giannini, Francesco</creator><general>Elsevier B.V</general><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20210901</creationdate><title>Aortic angle distribution and predictors of horizontal aorta in patients undergoing transcatheter aortic valve replacement</title><author>Moscarelli, Marco ; 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Physiological range of aortic angle (AA) is unknown; hence there is no cutoff AA for classifying HA. Moreover, patient characteristics predicting HA are under-investigated.
This was a retrospective analysis of prospective collected data from 16 heart valve centers in Europe. The study utilized a common dataset with a priori agreed-upon definitions and variables. Eligible patients underwent TAVR between 2014 and 2020 and had multidetector computed tomographic imaging data available for determining the AA. The analysis described the distribution of AA and potential predictors of HA. Inter-center variability was also explored.
For 4022 patients analyzed, the mean AA ± standard deviation was 49.4° ± 9.4° (median 49°, inter-quartile range [IQR] 12°, range 18–90°). There was no significant difference in mean AA between men and women (49.4° ± 9.1° vs. 49.6° ± 9.3°, respectively; p = 0.53); therefore, 49.4° was accepted as the cutoff value for HA in subsequent analyses. Covariates significantly associated with HA included age (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 1.01–1.04, p < 0.001), body mass index (OR: 1.06, 95% CI: 1.05–1.08, p < 0.01), previous cardiac surgery (OR: 0.58, 95% CI: 0.45–0.75, p < 0.001), and porcelain aorta (OR: 0.66, 95% CI: 0.52–0.85, p = 0.001). Some inter-center variability was observed.
We defined 49.4° as the mean AA, and also associated predictors of HA in a large case series of patients with severe aortic stenosis candidates for TAVR.
•What is the physiological aortic angle distribution in TAVR patients?•Mean aortic angle in a large series of TAVR patients with aortic stenosis was 49.4°.•Higher aortic angle values were observed in the elderly and in the obese.</abstract><pub>Elsevier B.V</pub><doi>10.1016/j.ijcard.2021.05.054</doi><tpages>5</tpages></addata></record> |
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| subjects | Aortic angle Horizontal aorta Obesity paradox TAVR Transcatheter aortic valve replacement |
| title | Aortic angle distribution and predictors of horizontal aorta in patients undergoing transcatheter aortic valve replacement |
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