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Measurement of aortic valve calcification using multislice computed tomography: correlation with haemodynamic severity of aortic stenosis and clinical implication for patients with low ejection fraction.
MedLine Citation:
PMID:  20720250     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Background Measurement of the degree of aortic valve calcification (AVC) using electron beam computed tomography (EBCT) is an accurate and complementary method to transthoracic echocardiography (TTE) for assessment of the severity of aortic stenosis (AS). Whether threshold values of AVC obtained with EBCT could be extrapolated to multislice computed tomography (MSCT) was unclear and AVC diagnostic value in patients with low ejection fraction (EF) has never been specifically evaluated. Methods Patients with mild to severe AS underwent prospectively within 1&emsp14;week MSCT and TTE. Severe AS was defined as an aortic valve area (AVA) of less than 1&emsp14;cm(2). In 179 patients with EF greater than 40% (validation set), the relationship between AVC and AVA was evaluated. The best threshold of AVC for the diagnosis of severe AS was then evaluated in a second subset (testing set) of 49 patients with low EF (≤40%). In this subgroup, AS severity was defined based on mean gradient, natural history or dobutamine stress echocardiography. Results Correlation between AVC and AVA was good (r=-0.63, p<0.0001). A threshold of 1651 arbitrary units (AU) provided 82% sensitivity, 80% specificity, 88% negative-predictive value and 70% positive-predictive value. In the testing set (patients with low EF), this threshold correctly differentiated patients with severe AS from non-severe AS in all but three cases. These three patients had an AVC score close to the threshold (1206, 1436 and 1797&emsp14;AU). Conclusions In this large series of patients with a wide range of AS, AVC was shown to be well correlated to AVA and may be a useful adjunct for the evaluation of AS severity especially in difficult cases such as patients with low EF.
Authors:
Caroline Cueff; Jean-Michel Serfaty; Claire Cimadevilla; Jean-Pierre Laissy; Dominique Himbert; Florence Tubach; Xavier Duval; Bernard Iung; Maurice Enriquez-Sarano; Alec Vahanian; David Messika-Zeitoun
Publication Detail:
Type:  Journal Article     Date:  2010-08-18
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  97     ISSN:  1468-201X     ISO Abbreviation:  Heart     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-04-08     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  England    
Other Details:
Languages:  eng     Pagination:  721-6     Citation Subset:  AIM; IM    
Affiliation:
Cardiovascular division, Bichat Hospital, 46 rue Henri Huchard, 75018 Paris, France; david.messika-zeitoun@bch.aphp.fr.
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