scholarly journals Aortic Valve Calcium Score as Measured by Native Vs. Contrast Enhanced Computer Tomography and the Implications for the Diagnosis of Severe Aortic Stenosis in TAVR Patients With Low Gradient Aortic Stenosis.

2021 ◽  
Author(s):  
Mohammad El Garhy ◽  
Ellizabeth Costello
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Hounsfield Unit ◽  
Calcium Score ◽  
Agatston Score ◽  
Score Threshold ◽  
Contrast Enhanced ◽  
Artery Disease ◽  
Contrast Ct

Abstract Purposewe compared between patients with low gradient (LG) and high gradient (HG) severe aortic stenosis (AS) as regard the burden of aortic valve calcium (AVC) using different methodologies. Moreover, we evaluated the accuracy of published thresholds for the diagnosis of severe AS in both groups. Methodswe measured the calcium volume and score using Agatston methodology in non-contrast (n-c) CT and with modified and fixed 850 Hounsfield unit (HU) thresholds in contrast enhanced (ce) CT. ResultsThe medians (IQR) of Agatston score, score with 850 HU and modified thresholds were 1288 AU (750-1815), 101 (65-256), 701 (239-1632), respectively. The calcium volume in ceCT using fixed 850 HU thresholds is significantly lower than the assessed volume in ncCT or in ceCT using modifiable threshold. LG patients were more obese; BMI 31.2 (29.1-35.1) vs 27.6 (26-31) and presented more with coronary artery disease (71.4% vs 40%). AF was documented in 42% in LG-patients vs 30% in HG patients. LVEF was severely depressed (less than 30%) in 28.6% in LG-patients. LG patients were more symptomatic (NYHA ≥ III in 71.4% patients vs 42%).The LG patients had smaller anatomy: annulus diameter 23.5mm (21.5-27) vs 25mm (23-25.5), LVOT diameter 23mm (20-20) vs 25mm (23-26.7mm). The annulus geometry was more eccentric; eccentric index 0.23 (0.19-0.27) vs 0.11 (0.1-0.2). Agatston score and calcium volume were lower in patients with LG; 1641AU (1292-1990) vs 928AU (572-1284) and 1537mm³ (644-1860) vs 286mm³ (160-700), respectively. Only 20% of patients with LG had Agatston score less than the previously supposed AVC score threshold for the diagnosis of severe AS (>2000AU in men and >1200 in women). The elimination of ncCT from the protocol reduced significantly the radiation dose by 400.3 ± 140 mGy*cm and 2.4 ± 2.8mSv.ConclusionThe diagnosis of severe LGAS should not depend on a single parameter as calcium score. The measurement of calcium score in contrast CT underestimate the calcium load significantly.

scholarly journals Contrast-enhanced computed tomography assessment of aortic stenosis

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318556
Author(s):  
Timothy RG Cartlidge ◽  
Rong Bing ◽  
Jacek Kwiecinski ◽  
Ezequiel Guzzetti ◽  
Tania A Pawade ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Ex Vivo ◽  
Agatston Score ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Stenosis Severity ◽  
Jet Velocity ◽  
Contrast Ct

ObjectivesNon-contrast CT aortic valve calcium scoring ignores the contribution of valvular fibrosis in aortic stenosis. We assessed aortic valve calcific and non-calcific disease using contrast-enhanced CT.MethodsThis was a post hoc analysis of 164 patients (median age 71 (IQR 66–77) years, 78% male) with aortic stenosis (41 mild, 89 moderate, 34 severe; 7% bicuspid) who underwent echocardiography and contrast-enhanced CT as part of imaging studies. Calcific and non-calcific (fibrosis) valve tissue volumes were quantified and indexed to annulus area, using Hounsfield unit thresholds calibrated against blood pool radiodensity. The fibrocalcific ratio assessed the relative contributions of valve fibrosis and calcification. The fibrocalcific volume (sum of indexed non-calcific and calcific volumes) was compared with aortic valve peak velocity and, in a subgroup, histology and valve weight.ResultsContrast-enhanced CT calcium volumes correlated with CT calcium score (r=0.80, p<0.001) and peak aortic jet velocity (r=0.55, p<0.001). The fibrocalcific ratio decreased with increasing aortic stenosis severity (mild: 1.29 (0.98–2.38), moderate: 0.87 (1.48–1.72), severe: 0.47 (0.33–0.78), p<0.001) while the fibrocalcific volume increased (mild: 109 (75–150), moderate: 191 (117–253), severe: 274 (213–344) mm3/cm2). Fibrocalcific volume correlated with ex vivo valve weight (r=0.72, p<0.001). Compared with the Agatston score, fibrocalcific volume demonstrated a better correlation with peak aortic jet velocity (r=0.59 and r=0.67, respectively), particularly in females (r=0.38 and r=0.72, respectively).ConclusionsContrast-enhanced CT assessment of aortic valve calcific and non-calcific volumes correlates with aortic stenosis severity and may be preferable to non-contrast CT when fibrosis is a significant contributor to valve obstruction.

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 Sex difference in aortic valve fibrosis assessed by contrast-enhanced computed tomography in severe aortic stenosis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
V Myasoedova ◽  
E Fraschini ◽  
G Mostardini ◽  
L Bonfanti ◽  
M Chiesa ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Sex Difference ◽  
Severe Aortic Stenosis ◽  
Aortic Valve Area ◽  
Men And Women ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct

Abstract Background Aortic stenosis (AS) is characterized by fibro-calcific remodeling of aortic valve leaflets. Progressive aortic valve calcification (AVC) occurs in both sexes and cardiac computed tomography (CT) is recognized as a high-quality technique for AVC evaluation. To date, sex-specific CT thresholds of AVC have been implemented in clinical practice since it is now recognized that women have less AVC burden than men. In addition, recent evidences indicate that women have more fibrotic remodeling of aortic valve leaflet compared to men. Purpose Aortic valve fibrosis (AVF) being a significant contributor to valve gradient, we sought to evaluate the difference in AVF burden between men and women with severe AS using contrast-enhanced CT. Methods We included 56 patients matched for age and sex with severe AS. All patients underwent Doppler echocardiography and cardiac CT before intervention. Contrast attenuation values (Hounsfield Units, HU) and contrast-to-noise ratio were measured at the level of the ascending aorta. Total AVF was assessed based on HU ranging between 30 and 350, adjusting the upper threshold by increments of 25 HU in either direction until blood pool was not highlighted. Indexed contrast-enhanced CT calcium volume (iAVC) and fibrosis volume (iAVF) were calculated dividing the volumes by the aortic annular area. Fibro-calcific ratio was calculate dividing iAVF by iAVC volumes. Results There was no difference between men and women in major cardiovascular risk factors, valve phenotype (bicuspid vs. tricuspid), nor pharmacological treatment. Men had higher body surface area than women (1.89±0.14 vs. 1.67±0.17 m2, respectively; p&lt;0.001), while women had lower aortic valve area than men (AVA; 0.74±0.2 vs. 0.91±0.2 cm2, respectively; p=0.007) but similar indexed AVA (0.44±0.15 vs. 0.48±0.12 cm2/m2, respectively; p=0.262). Women had significantly lower iAVC compared to men (36 [36–72] vs. 72 [67–123] mm3/cm2, respectively; p=0.03). However, iAVF was significantly higher in women compared to men (83 [78–123] vs. 63 [58–83] mm3/cm2, respectively; p=0.006). Finally, the fibro-calcific ratio, which indicates the predominance of valve fibrosis if &gt;1.0, was significantly higher in women compared to men (2.57 [2.14–7.02] vs. 0.78 [0.84–2.02], respectively; p=0.003). Conclusions Our study highlights for the first time a sex difference in the fibrotic content of severe AS evaluated by contrast-enhanced CT. These findings might be valuable to promote further studies on the role of sex-specific tissue composition in AS progression and outcomes. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Fondazione Gigi e Pupa Ferrari ONLUS

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