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

Abstract

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.

Effect of Denosumab or Alendronic Acid on the Progression of Aortic Stenosis: A Double-Blind Randomized Controlled Trial

“…We should consider whether we have failed to detect an effect of the intervention because of insensitivity of the measurements of aortic stenosis progression or a lack of power. We set out to undertake a comprehensive assessment of aortic stenosis severity and progression using 3 complementary but distinctly independent methods: aortic valve calcium scoring, Doppler echocardiography, and 18 F-NaF PET-CT. Aortic valve calcium scoring and echocardiography are standard clinical tools used to assess disease severity, 24 , 36 , 37 and we were able to identify and quantify disease progression across all 3 trial treatment arms using both of these methods. We observed an overall rate of hemodynamic progression that is consistent with published series and trials.…”

“…However, we have recently examined the contemporary use of aortic valve calcium scoring for assessing disease progression and demonstrated that modest sample sizes, not dissimilar to our present study, are needed to detect the desired effect size sought here. 24 …”

“…Standard 2-dimensional views and pulsed and continuous wave Doppler measurements were acquired, with Doppler measurements averaged over 3 cardiac cycles or 5 if the patient was in atrial fibrillation. 24 Aortic valve mean pressure gradient was calculated using the Bernoulli equation. Aortic valve area was estimated using the continuity equation.…”

Artificial Intelligence-Based Spiral CT 3D Reconstruction in Transcatheter Aortic Valve Implantation

“…Preoperative evaluation of TTE can measure the internal anatomical structure and valve size of the heart in real time, but it is easily affected by the operator level and aortic valve calcification, so the measurement results of TTE are small. Doris et al [ 33 ] evaluated the severity of aortic stenosis in patients with aortic valve calcification by CT quantification (CT-AVC) and conducted a comparative study with echocardiography. The results showed that CT-AVC was reproducible and the measurement reproducibility became more standardized over time, with higher accuracy than echocardiography, which was similar to the results of this research.…”

Heartbeat: cardiovascular health in the time of COVID-19

“…Other interesting papers in this issue of Heart include a study by Doris and colleagues 4 showing that in adults with aortic stenosis CT quantitation of valve calcification is reproducible and In a study of patients undergoing atrial fibrillation (AF) ablation, Piccini and colleagues 6 found that almost 30% experienced recurrent atrial tachycardiac (AT) or AF within 3 months. However, although those without recurrent AT/AF had greater improvement in functional status, overall quality of life was similar in those with and without AT/AF recurrence.…”