Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://cr.elmerpub.com

Original Article

Volume 17, Number 4, August 2026, pages 338-346

Aortic Valve and Left Ventricular Outflow Tract Calcification as Predictors of Early Complications After Transcatheter Aortic Valve Implantation: A Prospective Single-Center Study

↓ Figure 1. ROC curve for prediction of post-TAVI paravalvular leak using aortic calcium score. ROC: receiver operating characteristic; TAVI: transcatheter aortic valve implantation.

↓ Figure 2. ROC curve for prediction of post-TAVI high-grade AV block using aortic valve calcium score. ROC: receiver operating characteristic; TAVI: transcatheter aortic valve implantation; AV: atrioventricular.

↓ Figure 3. ROC curve for prediction of postimplantation dilatation using the aortic valve calcium score. ROC: receiver operating characteristic.

↓ **Table 1.** Baseline Data of Studied Patients (N = 95)
Variables	Results
Data expressed as mean (SD), frequency (percentage). BMI: body mass index; BSA: body surface area; CrCl: creatinine clearance; EuroSCORE II: European System for Cardiac Operative Risk Evaluation II; SD: standard deviation.
Age (years)	73.144 ± 5.998
Sex
Male	58 (61.05%)
Female	37 (38.9%)
Weight (kg)	82.979 ± 14.951
Height (cm)	163.854 ± 8.513
BMI (kg/m²)	30.930 ± 6.080
BSA (m²)	1.895 ± 0.181
EuroScore II, %	0.951 ± 1.823
CrCl (mL/min)	87.016 ± 29.158

↓ Table 1. Baseline Data of Studied Patients (N = 95)

Variables

Results

Data expressed as mean (SD), frequency (percentage). BMI: body mass index; BSA: body surface area; CrCl: creatinine clearance; EuroSCORE II: European System for Cardiac Operative Risk Evaluation II; SD: standard deviation.

Age (years)

73.144 ± 5.998

Sex

Male

58 (61.05%)

Female

37 (38.9%)

Weight (kg)

82.979 ± 14.951

Height (cm)

163.854 ± 8.513

BMI (kg/m²)

30.930 ± 6.080

BSA (m²)

1.895 ± 0.181

EuroScore II, %

0.951 ± 1.823

CrCl (mL/min)

87.016 ± 29.158

↓ **Table 2.** Preoperative ECG, Echocardiographic Parameters Among the Studied Patients (N = 95)
Variables	Results
AF: atrial fibrillation; BBB: bundle branch block; LBBB: left bundle branch block; RBBB: right bundle branch block; EF: ejection fraction; SWT: septal wall thickness; PWT: posterior wall thickness; LVEDD: left ventricular end diastolic diameter; LVESD: left ventricular end systolic diameter; PPG: photoplethysmography; MPG: mean pressure gradient; AVA: aortic valve area; RVSP: right ventricular systolic pressure; AR: aortic regurgitation.
AF
No	84 (88.4%)
Permanent	5 (5.2%)
Paroxysmal	6 (6.3%)
BBB
No	82 (86.3%)
LBBB	6 (6.3%)
RBBB	7 (7.3%)
PR interval duration (ms)	154.6 ± 55.4
QRS duration (ms)	89.8 ± 17.7
EF (%)	60.813 ± 12.151
SWT (mm)	13.542 ± 1.615
PWT (mm)	13.031 ± 1.209
LVEDD (mm)	50.802 ± 7.969
LVESD (mm)	33.349 ± 7.886
PPG (mm Hg)	85.900 ± 23.057
MPG (mm Hg)	53.444 ± 15.334
AVA (cm)	0.750 ± 0.157
RVSP (mm Hg)	40.896 ± 12.479
AR
0	0 (0%)
1	71 (74.7%)
2	18 (18.9%)
3	5 (5.2%)
4	1 (1%)

↓ Table 2. Preoperative ECG, Echocardiographic Parameters Among the Studied Patients (N = 95)

Variables

Results

AF: atrial fibrillation; BBB: bundle branch block; LBBB: left bundle branch block; RBBB: right bundle branch block; EF: ejection fraction; SWT: septal wall thickness; PWT: posterior wall thickness; LVEDD: left ventricular end diastolic diameter; LVESD: left ventricular end systolic diameter; PPG: photoplethysmography; MPG: mean pressure gradient; AVA: aortic valve area; RVSP: right ventricular systolic pressure; AR: aortic regurgitation.

84 (88.4%)

Permanent

5 (5.2%)

Paroxysmal

6 (6.3%)

BBB

82 (86.3%)

LBBB

6 (6.3%)

RBBB

7 (7.3%)

PR interval duration (ms)

154.6 ± 55.4

QRS duration (ms)

89.8 ± 17.7

EF (%)

60.813 ± 12.151

SWT (mm)

13.542 ± 1.615

PWT (mm)

13.031 ± 1.209

LVEDD (mm)

50.802 ± 7.969

LVESD (mm)

33.349 ± 7.886

PPG (mm Hg)

85.900 ± 23.057

MPG (mm Hg)

53.444 ± 15.334

AVA (cm)

0.750 ± 0.157

RVSP (mm Hg)

40.896 ± 12.479

0 (0%)

71 (74.7%)

18 (18.9%)

5 (5.2%)

1 (1%)

↓ **Table 3.** Preoperative CT Parameters Among the Studied Patients (N = 95)
Variables	Results
LMCA: left main coronary artery; RCA: right coronary artery; MS: mitral stenosis; LVOT: left ventricular outflow tract; RHD: rheumatic heart disease; BAV: bicuspid aortic valve
Annulus diameter (mm)	23.81 ± 2.55
Annulus perimeter (mm)	77.35 ± 7.75
LMCA (mm)	12.98 ± 2.33
RCA (mm)	16.02 ± 2.87
MS (mm)	9 (4–14)
Grade of aortic valve Calcification
1	13 (13.6%)
2	20 (20.8%)
3	33 (34.4%)
4	29 (30.2%)
LVOT calcification	17 (17.7%)
Septal bulge	22 (23.15%)
RHD	10 (10.5%)
BAV	16 (16.8%)
Overall horizontal aorta	20 (20%)
Horizontal aorta in bicuspid aortic valve	3 (15%)

↓ Table 3. Preoperative CT Parameters Among the Studied Patients (N = 95)

Variables

Results

LMCA: left main coronary artery; RCA: right coronary artery; MS: mitral stenosis; LVOT: left ventricular outflow tract; RHD: rheumatic heart disease; BAV: bicuspid aortic valve

Annulus diameter (mm)

23.81 ± 2.55

Annulus perimeter (mm)

77.35 ± 7.75

LMCA (mm)

12.98 ± 2.33

RCA (mm)

16.02 ± 2.87

MS (mm)

9 (4–14)

Grade of aortic valve Calcification

13 (13.6%)

20 (20.8%)

33 (34.4%)

29 (30.2%)

LVOT calcification

17 (17.7%)

Septal bulge

22 (23.15%)

RHD

10 (10.5%)

BAV

16 (16.8%)

Overall horizontal aorta

20 (20%)

Horizontal aorta in bicuspid aortic valve

3 (15%)

↓ **Table 4.** Operative Data of the Studied Patients (N = 95)
Variables	Results
Data are expressed as mean (SD) and frequency (percentage). DI: depth of implant.
DI (mm)	3.59 ± 1.38
Preimplantation dilatation	62 (65.2%)
Postimplantation dilatation	32 (33.6%)
Used approach
Percutaneous	60 (63.1%)
Surgical	35 (36.9%)
Access site
Right femoral	84 (88.4%)
Left femoral	10 (11.6%)
Subclavian	1 (1%)

↓ Table 4. Operative Data of the Studied Patients (N = 95)

Variables

Results

Data are expressed as mean (SD) and frequency (percentage). DI: depth of implant.

DI (mm)

3.59 ± 1.38

Preimplantation dilatation

62 (65.2%)

Postimplantation dilatation

32 (33.6%)

Used approach

Percutaneous

60 (63.1%)

Surgical

35 (36.9%)

Access site

Right femoral

84 (88.4%)

Left femoral

10 (11.6%)

Subclavian

1 (1%)

↓ **Table 5.** Complications Among the Studied Patients
Complications	Number of patients
CIN: contrast-induced nephropathy; CVS: cerebrovascular stroke; MPG: mean pressure gradient; PPM: permanent pacemaker implantation.
High-grade AV block requiring PPM	5 (5.2%)
CVS	3 (3.1%)
CIN	3 (3.1%)
Stage 1	2
Stage 2, 3	0
Stage 4	1
Hemorrhage	7 (7.36%)
Type 1	6
Type 2	1
Type 3, 4	0
Valve embolization	1 (1%)
Initial paravalvular leak (> 2)	14 (14.7%)
Final paravalvular leak after post dilatation (> 2)	0
Residual immediate MPG (mm Hg, > 10)	7
Residual MPG after dilatation (mm Hg, > 10)	0
Overall complications	40 (42.1%)

↓ Table 5. Complications Among the Studied Patients

Complications

Number of patients

CIN: contrast-induced nephropathy; CVS: cerebrovascular stroke; MPG: mean pressure gradient; PPM: permanent pacemaker implantation.

High-grade AV block requiring PPM

5 (5.2%)

CVS

3 (3.1%)

CIN

3 (3.1%)

Stage 1

Stage 2, 3

Stage 4

Hemorrhage

7 (7.36%)

Type 1

Type 2

Type 3, 4

Valve embolization

1 (1%)

Initial paravalvular leak (> 2)

14 (14.7%)

Final paravalvular leak after post dilatation (> 2)

Residual immediate MPG (mm Hg, > 10)

Residual MPG after dilatation (mm Hg, > 10)

Overall complications

40 (42.1%)

↓ **Table 6.** Cut-Off Points for Aortic Valve Calcification Measurements as Predictors for Different Study Variables
Variables	Cut-off point	Sensitivity	Specificity	PPV	NPV	AUC
AUC: area under the curve; AV: atrioventricular; NPV: negative predictive value; PPV: positive predictive value; TAVI: transcatheter aortic valve implantation.
Post-TAVI paravalvular leak
Calcium score	2,206	85.71%	50%	22.64%	95.35%	0.700
Post-TAVI high grade AV block
Calcium score	1,972	88.89%	40.23%	97.22%	13.33%	0.660
Postimplantation dilatation
Calcium score	2,900	54%	71%	79.07%	43.20%	0.64

↓ Table 6. Cut-Off Points for Aortic Valve Calcification Measurements as Predictors for Different Study Variables

Variables

Cut-off point

Sensitivity

Specificity

PPV

NPV

AUC

AUC: area under the curve; AV: atrioventricular; NPV: negative predictive value; PPV: positive predictive value; TAVI: transcatheter aortic valve implantation.

Post-TAVI paravalvular leak

Calcium score

2,206

85.71%

50%

22.64%

95.35%

0.700

Post-TAVI high grade AV block

Calcium score

1,972

88.89%

40.23%

97.22%

13.33%

0.660

Postimplantation dilatation

Calcium score

2,900

54%

71%

79.07%

43.20%

0.64