Aortic valve calcification is subject to aortic stenosis severity and the underlying flow pattern

Abstract

Sex- and flow-related aortic valve calcification (AVC) studies are still limited in number, and data on the exact calcium quantity and distribution are scarce. Therefore, we aimed to (1) re-define the best threshold of AVC load to distinguish severe from moderate aortic stenosis (AS) in common AS entities and to (2) evaluate differences in the aortic annulus and left ventricular outflow tract (LVOT) calcium load. Nine hundred and thirty-eight patients with contrast-enhanced cardiac MSCT and moderate-to-severe aortic stenosis (AS) were retrospectively enrolled. Patients with severe AS ≤ 1.0 cm2 (n = 841) were further separated into three AS entities: high gradient (HGAS, n = 370, 44.0%), paradoxical low gradient (pLGAS, n = 333, 39.6%), and classical low gradient (LGAS, n = 138, 16.4%). AVC, leaflet, and LVOT calcification were quantified. Aortic valve calcification scores were highest in severe HGAS, and lower in severe pLGAS and classical LGAS. In all severity and AS entities, the non-coronary cusp (NCC) was the most calcified one. LVOT calcification was consistently comparable between gender and AS entities. Accuracy of logistic regression was the highest in HGAS (male vs. female: AVC > 2156 Agatston units (AU), c-index 0.76; vs. AVC > 1292 AU, c-index 0.85; or AVC density > 406 AU/cm2, c-index 0.82; vs. > 259 AU/cm2, c-index 0.86; each p < 0.0001*) to diagnose severe AS. AVC could only be used in men to differentiate between severe LGAS and moderate AS. Data from this retrospective analysis indicate that the NCC is subject to pre-dominant degeneration throughout gender, AS severity, and several AS entities. AVC was consistently comparable in severe pLGAS and classical LGAS, but only AVC in severe LGAS could sufficiently distinguish from moderate AS in men. LVOT calcification failed to be a reliable indicator of accelerating AS.

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.

“…(Cheng, Chang et al 2017). In previous CT studies of TAVR, the incidence of LG AS was between 33-56% (Pawade, Clavel et al 2018;Veulemans, Piayda et al 2021), which is consistent with the 41.2% incidence we found. This high incidence of LG AS in TAVR patients highlights the importance of studying this entity.…”

“…We report here that only 20% of severe AS patients with LG had a higher AVC volume when evaluated by MSCT than the published cutoff recommended for the diagnosis of severe AS. We also note that the mean AVC burden in this study was lower than in previously reported studies (Bittner, Arnold et al 2016;Pawade, Clavel et al 2018;Veulemans, Piayda et al 2021). We included more patients with LGAS; however, even in patients with high gradient AS the calcium load was lower than in prior studies.…”

“…Clavel and colleagues have reported that only 50% of patients with discordant AS had higher values than the cut off value. Patients with discordant AS also had a lower AVC burden (Veulemans, Piayda et al 2021), and this group of patients accounts for approximately30% of TAVR patients. The PG across the AV is determined not only by the AVarea, but also independently by ow in the LVOT, AVC-load, and systemic arterial compliance (Clavel, Messika-Zeitoun et al 2013).…”

“…The PG across the AV is determined not only by the AVarea, but also independently by ow in the LVOT, AVC-load, and systemic arterial compliance (Clavel, Messika-Zeitoun et al 2013). Veulemans et al showed that CT can diffrentiate the severity of LG AS only in men (Veulemans, Piayda et al 2021). This study evaluated the AVC in contrast enhanced CT (ceCT) with xed threshld of 600 Houns eld (HU).…”

Impact of left ventricular ejection fraction and preoperative hemoglobin level on perioperative adverse cardiovascular events in noncardiac surgery

“…The severity of pulmonary hypertension was derived from peak tricuspid valve regurgitation velocity. Severe aortic valve stenosis is currently defined by an aortic valve area < 1.0 cm 2 and/or a mean transaortic pressure gradient > 40 mm Hg and/or a peak aortic jet velocity (V max ) > 4 m/s [15,16].…”