Practical determination of aortic valve calcium volume score on contrast-enhanced computed tomography prior to transcatheter aortic valve replacement and impact on paravalvular regurgitation: Elucidating optimal threshold cutoffs

Bettinger, Nicolas; Khalique, Omar; Krepp, Joseph; Hamid, Nadira; Bae, David; Pulerwitz, Todd; Liao, Ming; Hahn, Rebecca T.; Vahl, Torsten; Nazif, Tamim; George, Isaac; Leon, Martin B.; Kodali, Susheel

doi:10.1016/j.jcct.2017.04.009

Cited by 34 publications

(42 citation statements)

References 32 publications

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“…As previously mentioned, this study demonstrated that the optimal adaptive thresholds proportional to PAavg provided comparable results to optimal fixed thresholds. Theoretically, the optimal adaptive threshold is presumed superior to the optimal fixed threshold, as demonstrated in a previous study with contrast-enhanced cardiac CT (14). Despite the comparable results, we plan to apply optimal adaptive attenuation thresholds to quantify CT pulmonary vascular volume ratios in future clinical studies, when considering the wide range (250.1-956.6 HU) of PAavg observed in this study.…”

Section: Discussionmentioning

confidence: 77%

“…Additionally, the optimal attenuation threshold should be used to achieve a better result for threshold-based quantification (8)(9)(10)(11)(12)(13)(14). A threshold-based segmentation approach is also used to quantify CT pulmonary vascular volume ratios; therefore attenuation thresholds for kjronline.org performed in 17 non-sedated patients, and prospectively ECG-triggered high-pitch spiral scanning was performed in one free-breathing sedated patient.…”

Section: Introductionmentioning

confidence: 99%

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Optimal Attenuation Threshold for Quantifying CT Pulmonary Vascular Volume Ratio

Goo

Park

2020

Korean J Radiol

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Objective: To evaluate the effects of attenuation threshold on CT pulmonary vascular volume ratios in children and young adults with congenital heart disease, and to suggest an optimal attenuation threshold. Materials and Methods: CT percentages of right pulmonary vascular volume were compared and correlated with percentages calculated from nuclear medicine right lung perfusion in 52 patients with congenital heart disease. The selected patients had undergone electrocardiography-synchronized cardiothoracic CT and lung perfusion scintigraphy within a 1-year interval, but not interim surgical or transcatheter intervention. The percentages of CT right pulmonary vascular volumes were calculated with fixed (80-600 Hounsfield units [HU]) and adaptive thresholds (average pulmonary artery enhancement [PAavg] divided by 2.50, 2.00, 1.75, 1.63, 1.50, and 1.25). The optimal threshold exhibited the smallest mean difference, the lowest p-value in statistically significant paired comparisons, and the highest Pearson correlation coefficient. Results: The PAavg value was 529.5 ± 164.8 HU (range, 250.1-956.6 HU). Results showed that fixed thresholds in the range of 320-400 HU, and adaptive thresholds of PAavg/1.75-1.50 were optimal for quantifying CT pulmonary vascular volume ratios. The optimal thresholds demonstrated a small mean difference of ≤ 5%, no significant difference (> 0.2 for fixed thresholds, and > 0.5 for adaptive thresholds), and a high correlation coefficient (0.93 for fixed thresholds, and 0.91 for adaptive thresholds). Conclusion: The optimal fixed and adaptive thresholds for quantifying CT pulmonary vascular volume ratios appeared equally useful. However, when considering a wide range of PAavg, application of optimal adaptive thresholds may be more suitable than fixed thresholds in actual clinical practice.

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Section: Discussionmentioning

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Optimal Attenuation Threshold for Quantifying CT Pulmonary Vascular Volume Ratio

Goo

Park

2020

Korean J Radiol

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“…The setting of the Hounsfield Units threshold strongly influences the detection and several approaches have been described in order to predict PVL. Fixed thresholds of 850‐HU in contrast CT, empiric cut‐offs of 550‐HU, relative thresholds compared to LA and scan‐specific individual HU‐thresholds were assumed to provide the best prediction of PVL . Nevertheless, no standardized and overall accepted setting is established to allow a comparison of calcium amount in different studies.…”

Section: Discussionmentioning

confidence: 99%

“…Fixed thresholds of 850-HU in contrast CT, empiric cut-offs of 550-HU, relative thresholds compared to LA and scan-specific individual HUthresholds were assumed to provide the best prediction of PVL. 15,[24][25][26] Nevertheless, no standardized and overall accepted setting is established to allow a comparison of calcium amount in different studies.…”

Section: Quantification Of Calcification and Effect Of Bav On Post-mentioning

confidence: 99%

Degree of valve calcification in patients undergoing transfemoral transcatheter aortic valve implantation with and without balloon aortic valvuloplasty: Findings from the multicenter EASE‐IT TF registry

Butter

Okamoto

Schymik

et al. 2019

Cathet Cardio Intervent

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Aims We aimed to assess whether the level of aortic root calcification is associated with BAV performance/omission during transcatheter aortic valve implantation (TAVI), and to explore related outcomes. Methods and results EASE‐IT TF was a prospective, observational, multicenter registry of patients undergoing TF‐TAVI with the Edwards SAPIEN 3, with or without BAV predilation. Valvular calcification was quantified from pre‐procedural multi‐slice computed tomography images and compared between BAV and no BAV patients. Data for 178 patients (55 BAV; 123 no BAV) were analyzed. There were no significant differences between groups in terms of regional/leaflet sector calcification volumes, maximum asymmetry between the different leaflet sectors, or total calcification scores. Overall, a greater‐than‐average leaflet calcification volume was independently predictive of ≥mild PVL (OR: 5.116; 95% CI: 1.042–38.35) and the need for post‐dilation (OR: 3.592; 95% CI: 1.173–12.14). The latter effect was abated in patients with BAV (OR: 1.837; 95% CI: 0.223–18.00) and intensified in those without BAV (OR: 5.575; 95% CI: 1.114–38.74). No other BAV‐dependent effects of calcification on outcomes were observed. Conclusions In the majority of transfemoral valve implantations, calcification does not appear to be the main driving factor in the decision to perform/omit BAV. Predilation may be valuable for reducing post‐dilation requirements in patients only with a greater degree of leaflet calcification.

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“…The degree of opacification in contrast-enhanced CTs is the result of a complex interaction of multiple variables related to patient (body size, cardiac output), scanner (scan delay and duration, radiation dose) and contrast material (iodine concentration and volume, injection rate, bolus shape). Therefore, the thresholds for calcium detection on contrastenhanced CT scans has not been standardized in the literature (74) and none of the studies has included prognostic information. The current evidence favors the use of noncontrast acquisitions for stenosis severity assessment using AVC measurement.…”

Section: Multidetector Computed Tomography In Asmentioning

confidence: 99%

Multimodality Imaging for Discordant Low-Gradient Aortic Stenosis: Assessing the Valve and the Myocardium

Guzzetti

Annabi

Clavel

2020

Front. Cardiovasc. Med.

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Aortic stenosis (AS) is a disease of the valve and the myocardium. A correct assessment of the valve disease severity is key to define the need for aortic valve replacement (AVR), but a better understanding of the myocardial consequences of the increased afterload is paramount to optimize the timing of the intervention. Transthoracic echocardiography remains the cornerstone of AS assessment, as it is universally available, and it allows a comprehensive structural and hemodynamic evaluation of both the aortic valve and the rest of the heart. However, it may not be sufficient as a significant proportion of patients with severe AS presents with discordant grading (i.e., an AVA ≤ 1 cm2 and a mean gradient <40 mmHg) which raises uncertainty about the true severity of AS and the need for AVR. Several imaging modalities (transesophageal or stress echocardiography, computed tomography, cardiovascular magnetic resonance, positron emission tomography) exist that allow a detailed assessment of the stenotic aortic valve and the myocardial remodeling response. This review aims to provide an updated overview of these multimodality imaging techniques and seeks to highlight a practical approach to help clinical decision making in the challenging group of patients with discordant low-gradient AS.

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Practical determination of aortic valve calcium volume score on contrast-enhanced computed tomography prior to transcatheter aortic valve replacement and impact on paravalvular regurgitation: Elucidating optimal threshold cutoffs

Cited by 34 publications

References 32 publications

Optimal Attenuation Threshold for Quantifying CT Pulmonary Vascular Volume Ratio

Optimal Attenuation Threshold for Quantifying CT Pulmonary Vascular Volume Ratio

Degree of valve calcification in patients undergoing transfemoral transcatheter aortic valve implantation with and without balloon aortic valvuloplasty: Findings from the multicenter EASE‐IT TF registry

Multimodality Imaging for Discordant Low-Gradient Aortic Stenosis: Assessing the Valve and the Myocardium

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