scholarly journals Computed tomography aortic valve calcium scoring for the assessment of aortic stenosis progression

Heart ◽  
2020 ◽  
Vol 106 (24) ◽  
pp. 1906-1913 ◽  
Author(s):  
Mhairi Katrina Doris ◽  
William Jenkins ◽  
Philip Robson ◽  
Tania Pawade ◽  
Jack Patrick Andrews ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Peak Velocity ◽  
Intraclass Correlation ◽  
Diagnostic Image Quality ◽  
Aortic Valve Area ◽  
Cohen’S D ◽  
Stenosis Severity ◽  
Cohen's D ◽  
Measurement Repeatability

ObjectiveCT quantification of aortic valve calcification (CT-AVC) is useful in the assessment of aortic stenosis severity. Our objective was to assess its ability to track aortic stenosis progression compared with echocardiography.MethodsSubjects were recruited in two cohorts: (1) a reproducibility cohort where patients underwent repeat CT-AVC or echocardiography within 4 weeks and (2) a disease progression cohort where patients underwent annual CT-AVC and/or echocardiography. Cohen’s d-statistic (d) was computed from the ratio of annualised progression and measurement repeatability and used to estimate group sizes required to detect annualised changes in CT-AVC and echocardiography.ResultsA total of 33 (age 71±8) and 81 participants (age 72±8) were recruited to the reproducibility and progression cohorts, respectively. Ten CT scans (16%) were excluded from the progression cohort due to non-diagnostic image quality. Scan-rescan reproducibility was excellent for CT-AVC (limits of agreement −12% to 10 %, intraclass correlation (ICC) 0.99), peak velocity (−7% to +17%; ICC 0.92) mean gradient (−25% to 27%, ICC 0.96) and dimensionless index (−11% to +15%; ICC 0.98). Repeat measurements of aortic valve area (AVA) were less reliable (−44% to +28%, ICC 0.85).CT-AVC progressed by 152 (65–375) AU/year. For echocardiography, the median annual change in peak velocity was 0.1 (0.0–0.3) m/s/year, mean gradient 2 (0–4) mm Hg/year and AVA −0.1 (−0.2–0.0) cm2/year. Cohen’s d-statistic was more than double for CT-AVC (d=3.12) than each echocardiographic measure (peak velocity d=0.71 ; mean gradient d=0.66; AVA d=0.59, dimensionless index d=1.41).ConclusionCT-AVC is reproducible and demonstrates larger increases over time normalised to measurement repeatability compared with echocardiographic measures.

scholarly journals Pace of progression of aortic stenosis severity in patients with tricuspid and bicuspid valve

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P.H Hamala ◽  
J.D.K Kasprzak ◽  
K.W.D Wierzbowska-Drabik
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Continuity Equation ◽  
Peak Pressure ◽  
Progression Rate ◽  
Funding Source ◽  
Aortic Valve Area ◽  
Time Points ◽  
Stenosis Severity ◽  
Valve Area

Abstract Background Knowledge about determinants and pace of aortic stenosis (AS) progression may improve classification to aortic valve replacement. We quantified and compared pace of AS progression in patients with tricuspid and bicuspid aortic valve (TAV and BAV) examined by transthoracic echocardiography (TTE) in years 2004–2019. Methods We analysed retrospectively 322 TTE performed in two time points (median time between examinations 31±31 months) in 161 AS patients (mean age 69±11 years, 101 male, 40 BAV), evaluating the changes of parameters reflecting AS severity: peak pressure gradient (PG), aortic valve area by planimetry (AVApl) and continuity equation (AVAce). Then we compared pace of AS progression (defined as change of parameters per year) between patients with BAV and TAV and searched for correlates of AS progression. Results Although patients with BAV were younger, cardiovascular risk factors profile and baseline AS advancement were similar in both groups, see Table. Severe AS was present in 20% in BAV and 21% in TAV, p=ns. Patients with BAV showed circa 3 times more rapid AS progression expressed as the increase of PG per year (18.5±41.3 mmHg vs 4.1±34.4 mmHg in TAV, p=0.03) and yearly AVAce decrease (−0.23±0.27 vs −0.03±0.32, p=0.028). Smaller AVA value at baseline predicted faster pace of AS progression (with correlation coefficient r=−0.34, p=0.002 for AVApl). Conclusion Progression rate of AS depends on valve morphology being more rapid in BAV with similar to TAV baseline AS severity. In the whole group pace of progression correlated negatively with baseline AVA. Funding Acknowledgement Type of funding source: None

scholarly journals Repeated echocardiographic imaging of aortic stenosis: Real-life lessons

2021 ◽  
Author(s):  
Jonathan Bray ◽  
Adrian Ionescu
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Intraclass Correlation ◽  
Real Life ◽  
Stroke Volume Index ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Volume Index ◽  
Aortic Valve Area ◽  
Valve Area

Background Timing of aortic valve intervention is dependent on the accuracy and reproducibility of echocardiographic (ECHO) parameters. We aimed to assess haemodynamic subsets of aortic stenosis (AS), their change over time, and variability of ECHO parameters. Method This retrospective, longitudinal study compared sequential ECHO over 15 months to identify concordant or discordant aortic valve area (AVA) and mean pressure gradient (MPG). Results We included 143 patients with a mean age of 76.0 years. The median length of time between studies was 112 days (IQR 38-208). Initially participants were classified as 10 (7.0%) mild, 49 (34.3%) moderate and 84 (58.7%) severe AS. In 80 (55.9%) AVA and MPG were concordant; stroke volume index (SVi) was <35ml/m2 in 53 (74.6%). AS severity was downgraded in 33 (23.1%) patients. MPG was most consistent and AVA was the least consistent between successive investigations (intraclass correlation coefficients R=0.86 and R=0.76, respectively). Even small variations in left ventricular outflow tract (LVOT) measurement of 1 standard deviation reclassified up to 67% of participants from severe to non-severe. Conclusion Almost half of patients with AS have valve area/gradient discordance. Variations in LVOT diameter measurement commensurate with clinical practice reclassified AS severity in up to 2/3 of cases. Change in AS severity should only be accepted following careful scrutiny of all available ECHO data.

P3696Correlates of the ratio of acceleration time to ejection time in patients with aortic stenosis: an echocardiographic and computed tomography study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Altes ◽  
M Sochala ◽  
D Attias ◽  
J Dreyfus ◽  
M Toledano ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Peak Velocity ◽  
Left Ventricular ◽  
Volume Index ◽  
Multivariate Linear Regression Analysis ◽  
Aortic Valve Area ◽  
Ejection Time ◽  
Acceleration Time

Abstract Background Acceleration time to ejection time ratio (AT/ET) prolongation is associated with increased mortality in patients with aortic stenosis (AS). Purpose To identify the determinants associated with increased AT/ET. Methods The relationships between AT/ET ratio, clinical and Doppler echocardiographic variables of interest in the setting of AS were studied in 1107 patients with AS and preserved left ventricular (LV) ejection fraction (EF), with Computed Tomography – Aortic Valve Calcium (CT-AVC) score studied in a subgroup of 342 patients. Results In univariate analysis, AT/ET ratio did correlate with aortic peak velocity (Vmax, r=0.57, p<0.0001), mean pressure gradient (MPG, r=0.60, p<0.0001), aortic valve area (AVA, r=−0.50, p<0.0001) and CT-AVC score (r=0.24, p<0.0001). An AT/ET ratio had a good accuracy to predict an aortic peak velocity ≥4 m/s, a MPG≥40 mmHg, or an AVA≤1.0 cm2, with an optimal cut-off value of 0.34. By multivariate linear regression analysis, presence of AS-related symptoms, decreased LV stroke volume index, LVEF, systolic blood pressure (SBP), absence of diabetes mellitus, and increased LV mass index, relative wall thickness, and Vmax were independently associated with increased AT/ET ratio (all P<0.05). In the subgroup of patients who underwent CT-AVC, CT-AVC score was independently associated with increased AT/ET ratio (P<0.05). Conclusion AT/ET ratio is related to echocardiographic and CT-AVC indices of AS severity. However, multiple intricate factors beyond hemodynamic and anatomic severity of AS influence AT/ET ratio including LV geometry, function and SBP. These findings should be considered when assessing AT/ET in patients with AS and preserved LVEF. Acknowledgement/Funding Local funding

scholarly journals Use of routinely captured echocardiographic data in the diagnosis of severe aortic stenosis

Heart ◽  
2018 ◽  
Vol 105 (2) ◽  
pp. 112-116 ◽  
Author(s):  
Steven M Bradley ◽  
Katie Foag ◽  
Khua Monteagudo ◽  
Pam Rush ◽  
Craig E Strauss ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Peak Velocity ◽  
Severe Aortic Stenosis ◽  
Clinical Care ◽  
Velocity Ratio ◽  
High Sensitivity ◽  
Aortic Valve Area

ObjectiveTo determine the implications of applying guideline-recommended definitions of aortic stenosis to echocardiographic data captured in routine clinical care.MethodsRetrospective observational study of 213 174 patients who underwent transthoracic echocardiographic imaging within Allina Health between January 2013 and October 2017. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of echocardiographic measures for severe aortic stenosis were determined relative to the documented interpretation of severe aortic stenosis.ResultsAmong 77 067 patients with complete assessment of the aortic valve, 1219 (1.6%) patients were categorised as having severe aortic stenosis by the echocardiographic reader. Relative to the documented interpretation, aortic valve area (AVA) as a measure of severe aortic stenosis had the high sensitivity (94.1%) but a low positive predictive value (37.5%). Aortic valve peak velocity and mean gradient were specific (>99%), but less sensitive (<70%). A measure incorporating peak velocity, mean gradient and dimensionless index (either by velocity time integral or peak velocity ratio) achieved a balance of sensitivity (92%) and specificity (99%) with little detriment in accuracy relative to peak velocity and mean gradient alone (98.9% vs 99.3%). Using all available data, the proportion of patients whose echocardiogram could be assessed for aortic stenosis was 79.8% as compared with 52.7% by documented interpretation alone.ConclusionA measure that used dimensionless index in place of AVA addressed discrepancies between quantitative echocardiographic data and the documented interpretation of severe aortic stenosis. These findings highlight the importance of understanding the limitations of clinical data as it relates to quality improvement efforts and pragmatic research design.

Aortic valve area calculation using 3D transesophageal echocardiography: Implications for aortic stenosis severity grading

2020 ◽  
Vol 37 (12) ◽  
pp. 2071-2081
Author(s):  
Alessandro Beneduce ◽  
Cristina Capogrosso ◽  
Francesco Moroni ◽  
Francesco Ancona ◽  
Giulio Falasconi ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Transesophageal Echocardiography ◽  
Aortic Valve Area ◽  
3D Transesophageal Echocardiography ◽  
Severity Grading ◽  
Stenosis Severity ◽  
Valve Area

scholarly journals Valvulo-Arterial Impedance and Dimensionless Index for Risk Stratifying Patients With Severe Aortic Stenosis

2021 ◽  
Vol 8 ◽  
Author(s):  
Yogamaya Mantha ◽  
Shutaro Futami ◽  
Shohei Moriyama ◽  
Michinari Hieda
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Continuous Wave ◽  
Left Ventricular ◽  
Low Flow ◽  
Aortic Valve Area ◽  
Arterial Impedance ◽  
Stenosis Severity ◽  
Lv Ejection Fraction

The hemodynamic effects of aortic stenosis (AS) consist of increased left ventricular (LV) afterload, reduced myocardial compliance, and increased myocardial workload. The LV in AS patients faces a double load: valvular and arterial loads. As such, the presence of symptoms and occurrence of adverse events in AS should better correlate with calculating the global burden faced by the LV in addition to the transvalvular gradient and aortic valve area (AVA). The valvulo-arterial impedance (Zva) is a useful parameter providing an estimate of the global LV hemodynamic load that results from the summation of the valvular and vascular loads. In addition to calculating the global LV afterload, it is paramount to estimate the stenosis severity accurately. In clinical practice, the management of low-flow low-gradient (LF-LG) severe AS with preserved LV ejection fraction requires careful confirmation of stenosis severity. In addition to the Zva, the dimensionless index (DI) is a very useful parameter to express the size of the effective valvular area as a proportion of the cross-section area of the left ventricular outlet tract velocity-time integral (LVOT-VTI) to that of the aortic valve jet (dimensionless velocity ratio). The DI is calculated by a ratio of the sub-valvular velocity obtained by pulsed-wave Doppler (LVOT-VTI) divided by the maximum velocity obtained by continuous-wave Doppler across the aortic valve (AV-VTI). In contrast to AVA measurement, the DI does not require the calculation of LVOT cross-sectional area, a major cause of erroneous assessment and underestimation of AVA. Hence, among patients with LG severe AS and preserved LV ejection fraction, calculation of DI in routine echocardiographic practice may be useful to identify a subgroup of patients at higher risk of mortality who may derive benefit from aortic valve replacement. This article aims to elucidate the Zva and DI in different clinical situations, correlate with the standard indexes of AS severity, LV geometry, and function, and thus prove to improve risk stratification and clinical decision making in patients with severe AS.

scholarly journals Discordant grading of aortic stenosis severity: which are the best cut-point values of aortic valve area and gradient to predict outcomes?

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P4729-P4729
Author(s):  
R. Capoulade ◽  
F. Le Ven ◽  
M. A. Clavel ◽  
J. G. Dumesnil ◽  
M. Arsenault ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Area ◽  
Cut Point ◽  
Stenosis Severity ◽  
Valve Area
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