Different Calcification Stage in Each Cusp of a Calcified Tricuspid Aortic Valve

Cheng, Ching‐Li; Chang, Hsiao-Huang; Huang, Pei-Jung; Wang, Weichen; Lin, Shan‐Yang

doi:10.1253/circj.cj-17-0129

Cited by 6 publications

(7 citation statements)

References 7 publications

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“…Cheng et al also reported that the NCC had the most calci cation and the LCC had the least calci cation. (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.…”

Section: Discussionsupporting

confidence: 91%

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.

Garhy

Costello

2021

Preprint

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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.

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Section: Discussionsupporting

confidence: 91%

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.

Garhy

Costello

2021

Preprint

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“…On the other hand, the use of single cusps is a much simpler approach for the study of the mechanisms behind the progression of aortic valve calcification. Given that each cusp on one valve can have a different degree of calcification [39], the possibility that both calcium quantification and histological and immunoshistochemical analysis could be performed on the same cusp further illustrates the usefulness of µCT. Finally, and in spite of this study being performed on only one third of the aortic valve, we have found BV/TV to be correlated with some clinical features of the subjects included.…”

Section: Discussionmentioning

confidence: 99%

Correlation of Micro-Computed Tomography Assessment of Valvular Mineralisation with Histopathological and Immunohistochemical Features of Calcific Aortic Valve Disease

Solache-Berrocal

Barral-Varela

Areces-Rodríguez

et al. 2019

JCM

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Aortic valve stenosis is a serious disease with increasing prevalence in developed countries. Research aimed at uncovering the molecular mechanisms behind its main cause, aortic valve calcification, is thus crucial for the development of future therapies. It is frequently difficult to measure the extent of mineralisation in soft tissues and some methods require the destruction of the sample. Micro-computed tomography (µCT), a non-destructive technique, was used to quantify the density and volume of calcium deposits on cusps from 57 explanted aortic valves. Conventional and immunostaining techniques were used to characterise valve tissue degeneration and the inflammatory and osteogenic stage with several markers. Although most of the analysed cusps came from severe stenosis patients, the µCT parameter bone volume/tissue volume ratio distinguished several degrees of mineralisation that correlated with the degree of structural change in the tissue and the amount of macrophage infiltration as determined by CD68 immunohistochemistry. Interestingly, exosomal markers CD63 and Alix co-localised with macrophage infiltration surrounding calcium deposits, suggesting that those vesicles could be produced at least in part by these immune cells. In conclusion, we have shown that the ex vivo assessment of aortic valve mineralisation with µCT reflects the molecular and cellular changes in pathological valves during progression towards stenosis. Thus, our results give additional validity to quantitative µCT as a convenient laboratory tool for basic research on this type of cardiovascular calcification.

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“…This is consistent with Veulemans et al who found that in AS of all severities and etiologies AS entities, the NCC was the most calcified. Cheng et al also reported that the NCC had the most calcification and the LCC had the least calcification [11].…”

Section: Discussionmentioning

confidence: 94%

Aortic valve calcium volume as measured by native versus contrast-enhanced computer tomography and the implications for the diagnosis of severe aortic stenosis in TAVR patients with low-gradient aortic stenosis

2022

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Background Most of TAVR centers evaluate the calcium score in contrast-enhanced (ce) CT. We compared in this study between different methodologies to measure calcium score. We studied also the difference between patients with low-gradient (LG) and high-gradient (HG) severe aortic stenosis (AS) as regard the burden of aortic valve calcium (AVC). Results We measured the calcium volume and score using Agatston methodology in non-contrast (nc) CT and with modified and fixed 850 Hounsfield unit (HU) thresholds in ce CT. The calcium score and volume in ceCT using even with modified thresholds is significantly lower than the assessed score and volume in ncCT. The median (IQR) of calcium score in nc CT and in cc CT were 1288 AU (750–1815) versus 947 HU (384–2202). The median (IQR) of calcium volume in nc CT and in cc CT with modified thresholds were 701 mm3 (239–1632) versus 197 mm3 (139–532). Agatston score and calcium volume were lower in patients with LG AS than HG AS; 2069 AU (899–2477) versus 928AU (572–1284) and 1537 mm3 (644–1860) versus 286 mm3 (160–700), respectively. Only 20% of patients with LGAS had Agatston score higher than the previously supposed AVC score threshold for the diagnosis of severe AS (> 2000AU in men and > 1200 in women). Conclusions The diagnosis of severe LGAS should not depend on a single parameter as calcium score. In these patients, calcium score should be measured in nc CT and not in ce CT.

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Different Calcification Stage in Each Cusp of a Calcified Tricuspid Aortic Valve

Cited by 6 publications

References 7 publications

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.

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.

Correlation of Micro-Computed Tomography Assessment of Valvular Mineralisation with Histopathological and Immunohistochemical Features of Calcific Aortic Valve Disease

Aortic valve calcium volume as measured by native versus contrast-enhanced computer tomography and the implications for the diagnosis of severe aortic stenosis in TAVR patients with low-gradient aortic stenosis

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