scholarly journals AORTIC VALVE CALCIUM SCORE CUT-OFFS USED TO IDENTIFY HEMODYNAMICALLY SEVERE AORTIC STENOSIS MAY NOT APPLY IN PATIENTS WITH CARDIAC AMYLOIDOSIS

2020 ◽  
Vol 75 (11) ◽  
pp. 2164
Author(s):  
Muzna Hussain ◽  
Mazen Hanna ◽  
Brian P. Griffin ◽  
Jay Patel ◽  
Agostina Fava ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Cardiac Amyloidosis ◽  
Severe Aortic Stenosis ◽  
Calcium Score

Abstract 11653: The Qualitative Grading of Aortic Valve Calcification in Severe Aortic Stenosis is Weakly Associated With Aortic Valve Weight and is Gender Dependent

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Dragos Alexandru ◽  
Florentina Petillo ◽  
Simcha Pollack ◽  
Nathaniel Reichek ◽  
Eddy Barasch
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Pearson Correlation ◽  
Calcium Score ◽  
Aortic Valve Calcification ◽  
Test Analysis ◽  
Valve Calcification ◽  
Exact Test ◽  
The Difference

Background: In severe aortic stenosis (AS), qualitative estimation of aortic valve calcification (AVC) burden by echocardiography has diagnostic and prognostic value. Hypothesis: there is a weak association between a qualitative calcium score (QCS) by TEE and AV weight in severe AS. Methods: Between 2010-2014, of 719 pts who underwent surgical AVR for isolated severe AS, QCS was feasible in 483 (67%): mean age 76.7 ± 9.5 yrs, 59% males, EF 56 ±12%, AVAi 0.35 ±0.09 cm2/m2, AVW 2.45 ± 0.09 g, QCS 3.5± 0.57, 11% bicuspid valves . AVC was determined using short- and long-axis views and graded as mild (1) localized, small, nondense calcifications to severe (4) extensive thickening and calcification of all cusps. TEEs were done on the day of surgery and excised valves were weighed. Independent t-test, Fisher’s exact test, analysis of variance, and Pearson correlation were done as appropriate. Results: Intraclass correlations for intra and interobserver variability were 0.76 and 0.53 , respectively.The association between indices of AS severity and AVC burden, is stronger for AVW than for QCS (table).19 pts had QCS = 2, 183 = 3 and 280 = 4. A QCS of 2 to 4 corresponded to an AVW of 1 to 6 g. The correlation between QCS and AVW was 0.11, p=.01, and 0.09, p =.04 when controlling for age, sex and BSA. QCS-AVW association was gender dependent : for females (196), who had a lower severity of stenosis, r=0.23, p=0.001, for males (286), r=0.02, p=.68 with p =.02 for the difference. Conclusions: 1. In severe AS, QCS by TEE has limited reliability with no relationship with AVW in males and a weak one in females. 2. The utilization of QCS in severe AS even when employing TEE is weakly associated with total AVC burden and should probably be replaced by quantitative objective non- echocardiographic methods.

scholarly journals 199 Lower aortic valve calcium scores by computed tomography scan. A potential new red flag of concomitant cardiac amyloidosis in patients with severe aortic stenosis

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Alberto Ponziani ◽  
Giulia Saturi ◽  
Laura Santona ◽  
Maurizio Sguazzotti ◽  
Angelo Giuseppe Caponetti ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Bone Scintigraphy ◽  
Cardiac Amyloidosis ◽  
Calcium Score ◽  
P Value ◽  
Computed Tomography Scan ◽  
S Wave ◽  
Tomography Scan

Abstract Aims Cardiac amyloidosis (CA) and degenerative aortic stenosis (AS) are two diseases often combined but the diagnosis of both these conditions is challenging because these two illnesses share common echocardiographic characteristics. Different predictors have been proposed in the last few years, including clinical, ECG-graphic, and echocardiographic features. To identify a new marker of concomitant CA in patients with severe AS using computed tomography scan (CT). Methods and results Fifty-five patients with severe AS and suspicion of concomitant CA were retrospectively enrolled. Patients with a bicuspid aortic valve, previous aortic valve replacement, or an incomplete diagnostic workup for CA were excluded. Thirty-three patients underwent CT-scan and were included in the final analysis. None of the patients had at laboratory tests suspicion for AL amyloidosis; 12 patients (AS-CA) had positive 99 m Tc-DPD bone scintigraphy (two with visual score 1, eight score 2 and two score 3), 21 patients (AS-alone) had negative bone scintigraphy (visual score 0). AS-CA patients had a median age of 85.5 years (vs. 82) with only one female patient (vs. 8 in the AS-alone group). AVA indexed were almost comparable between AS-CA and AS-alone groups (0.4 vs. 0.3 mm2/m2, P = 0.25). Stroke volume evaluated by pulsed Doppler, maximum and mean gradient were significatively lower in AS-CA group (respectively 30 vs. 41 ml/m2, P = 0.017, 62 vs. 74 mmHg, 0.038 and 33 vs. 46 mmHg, P = 0.022) with a higher percentage of paradoxical low flow-low gradient aortic stenosis in AS-CA group (7 patients, 58% vs. 3 patients in AS-alone 14%, P = 0.027), in line with the literature. ECG at first presentation in AS-CA group showed atrial fibrillation in eight patients (67%), vs. two patients in the AS-alone group (10%), and lower QRS voltages (peripheral QRS score 40 mV vs. 51 mV, P-value = 0.017; total QRS score 113 mV vs. 155 mV, P-value = 0.005). The echocardiogram showed a more thickened IVS and PW in AS-CA patients (17 vs. 15 mm, P = 0.05 and 15 vs. 14 mm, P = 0.013), an increased left ventricular mass (441 vs. 356 g, P = 0.036) with a reduction of longitudinal systolic function (septal S wave at TDI 4.4 vs. 5.2 cm/s, P = 0.026, lateral S wave 4.1 vs. 5.6 cm/s, P = 0.024) and a lower myocardial contraction fraction (12% vs. 14%, P = 0.036). CT-aortic valve calcium was valued and quantified by an experienced operator. A statistically significant difference between AS-CA and AS-alone groups was observed in calcium score (3345 vs. 4785 Hounsfield units, P = 0.037) calcium volume (2411 vs. 3626 mm2, P = 0.03) and calcium mass (687 vs. 1147 g, P = 0.023). Conclusions This study is the first to our knowledge to use relative aortic valve calcium score evaluation from CT imaging to define patients with severe AS with or without concomitant CA in addition to the classical clinical, ECG graphic, and echocardiographic features. CT-aortic valve calcium burner was significatively lower in patients with concomitant CA.

Abstract 14709: Dual Pathology of Severe Aortic Stenosis and Cardiac Amyloidosis: Multi-center Study of Prevalence and Outcome

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Christian Nitsche ◽  
Paul Scully ◽  
Kush Patel ◽  
Andreas Kammerlander ◽  
Tim Wollenweber ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Bone Scintigraphy ◽  
Valve Replacement ◽  
Light Chain ◽  
Medical Management ◽  
Cardiac Amyloidosis ◽  
Severe Aortic Stenosis ◽  
Dual Pathology

Background: Elderly patients with severe aortic stenosis (AS) are increasingly diagnosed with cardiac amyloidosis (CA). It is unclear whether dual AS-CA has worse outcomes or may even result in futility of transcatheter aortic valve replacement (TAVR). Objective: To identify diagnostic predictors and outcomes of AS-CA compared to lone AS. Methods: Severe AS TAVR referrals at three international sites underwent clinical and laboratory assessment, six-minute walk test, ECG, transthoracic echocardiography with strain analysis, and blinded research 99mTc-DPD bone scintigraphy (Perugini Grade-0 negative, 1-3 increasingly positive) prior to intervention. Transthyretin CA (ATTR) was diagnosed by bone scintigraphy, unremarkable serum/urine free light chain assessment; light-chain CA (AL) was diagnosis by endomyocardial biopsy. All-cause mortality was captured from national registries. Results: 408 patients (age 83.4±6.5 years, 49.8% male) were recruited. DPD bone scintigraphy was positive in 11.6% (n=47, Grade-1 3.7%[15]) Grade-2/3 7.9%[32]). Positivity was associated with QRS duration (OR 2.5, 95%CI 1.1-5.5, p=0.02), voltage/mass-ratio (OR 0.4, 95%CI 0.2-0.9, p=0.02), history of carpal tunnel syndrome (OR 1.6, 95%CI 1.1-2.3, p=0.02). An additional two cases had biopsy proven AL-CA. Heart Team decision (blinded to bone scintigraphy) resulted in TAVR in 333 (81.6%), surgical aortic valve replacement in 10 (2.5%) and medical management in 65 (15.9%). After a median of 1.7 years, 22.9% of patients had died. AS-CA had a worse 1-year mortality than lone AS (24.5 vs 13.9%, p=0.045, Figure 1A), but there was no difference post valve intervention (p=0.7), which improved outcomes in both lone AS and AS-CA compared to medical management (Figure 1B+C). Discussion: Dual pathology of AS-CA is common in elderly AS patients. AS-CA is prognostically slightly worse than lone AS, but not if treated by valve intervention. Based on this data, TAVR should not be witheld in AS-CA.

scholarly journals Different aortic valve calcium scores by computed tomography scan in patients with severe aortic stenosis and concomitant cardiac amyloidosis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
G Saturi ◽  
L Santona ◽  
M S Sguazzotti ◽  
A G Caponetti ◽  
P Massa ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Bone Scintigraphy ◽  
Cardiac Amyloidosis ◽  
Calcium Score ◽  
P Value ◽  
Computed Tomography Scan ◽  
S Wave ◽  
Tomography Scan

Abstract Background The coexistence of cardiac amyloidosis (CA) and degenerative aortic stenosis (AS) is increasing but the diagnosis is challenging because these two conditions share a common echocardiographic phenotype (1). Different predictors have been proposed in the last few years, including clinical, ECG-graphic and echocardiographic features (2–3). Purpose To identify a new marker of concomitant CA in patients with severe AS analyzing computed tomography scan (CT). Methods 55 patients with severe AS and suspicion of concomitant CA were retrospectively enrolled. Patients with a bicuspid aortic valve, previous aortic valve replacement, or an incomplete diagnostic workup for CA were excluded. 33 patients underwent CT-scan and were included in the final analysis. Results None of the patients presented laboratory suspicion for AL amyloidosis; 12 patients (AS-CA) had positive 99m Tc-DPD bone scintigraphy (two with visual score 1, eight score 2 and two score 3), 21 patients (AS-alone) had negative bone scintigraphy. AS-CA patients had a median age of 85,5 years (versus 81,5) with only one female patient (versus 8 in the AS-alone group). AVA indexed were comparable between AS-CA and AS-alone groups (0,4 versus 0, 3 mm2/m2, p: 0.25). Stroke volume evaluated by pulsed Doppler, maximum and mean gradient were significatively lower in AS-CA group (respectively 30 versus 41 ml/m2, p: 0.017, 62 versus 74 mmHg, 0.038 and 33 versus 46 mmHg, p:0.022) with a higher percentage of low flow-low gradient aortic stenosis in AS-CA group (7 patients, 58% vs 3 patients in AS-alone 14%, p: 0.027), in line with the literature. ECG at first presentation in AS-CA group showed atrial fibrillation in 8 patients (67%), versus 2 patients in the AS-alone group (10%), and lower QRS voltages (peripheral QRS score 40 mV vs 51 mV, p-value:0.017; total QRS score 113 mV versus 155 mV, p-value: 0.005). The echocardiogram showed a more thickened IVS and PW in AS-CA patients (17 versus 15 mm, p: 0.05 and 15 versus 14 mm, p: 0.013), an augmented left ventricular mass (441 versus 356 g, p: 0.036) with a decreases longitudinal systolic function (septal S wave at TDI 4.4 versus 5.2 cm/s, p: 0.026, lateral S wave 4.1 versus 5.6 cm/s, p: 0.024) and a reduction in myocardial contraction fraction (12 versus 14%, p: 0.036). CT- aortic valve calcium was quantified by an experienced operator. A statistically significant difference between AS-CA and AS-alone groups was observed in calcium score (3345 versus 4785 Hounsfield units, p: 0.037) calcium volume (2411 versus 3626 mm2, p: 0.03) and calcium mass (687 versus 1147 g, p: 0.023) Conclusions This study is the first to our knowledge to use relative aortic valve calcium score evaluation from CT imaging to characterize patients with severe AS with or without concomitant CA in addition to the classical clinical, ECG graphic, echocardiographic parameters. CT-aortic valve calcium burner was significatively lower in patients with concomitant CA. FUNDunding Acknowledgement Type of funding sources: None. CT scan and bone scintigraphy

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