Real‐time imaging required for optimal echocardiographic assessment of aortic valve calcification

Abstract

IntroductionAortic valve calcification (AVC), even without haemodynamic significance, may be prognostically import as an expression of generalized atherosclerosis, but techniques for echocardiographic assessment are essentially unexplored.MethodsTwo-dimensional (2D) echocardiographic recordings (Philips IE33) of the aortic valve in short-axis and long-axis views were performed in 185 consecutive patients within 1 week before surgery for aortic stenosis (n = 109, AS), aortic regurgitation (n = 61, AR), their combination (n = 8) or dilation of the ascending aorta (n = 7). The grey scale mean (GSMn) of the aortic valve in an end-diastolic short-axis still frame was measured. The same frame was scored visually 1–5 as indicating that the aortic valve was normal, thick, or had mild, moderate or severe calcification. The visual echodensity of each leaflet was determined real time applying the same 5-grade scoring system for each leaflet, and the average for the whole valve was calculated. Finally, a similar calcification score for the whole valve based on inspection and palpation by the surgeon was noted.ResultsVisual assessment of real-time images using the proposed scoring system showed better correlation with the surgical evaluation of the degree of valve calcification (r = 0·83, P<0·001) compared to evaluation of stop frames by visual assessment (r = 0·66, P<0·001) or the GSMn score (r = 0·64, P<0·001). High inter- and intra-observer correlations were observed for real-time visual score (both intraclass correlation coefficient = 0·93).ConclusionReal-time evaluation of the level of AVC is superior to using stop frames assessed either visually or by dedicated computer grey scale measurement software.

Aortic valve type and calcification as assessed by transthoracic and transoesophageal echocardiography

“…One hundred and sixty‐nine patients (118 men, 51 women) were consecutively included in this study. Data on TTE findings with regard to this population have been described in a previous study from our group (Yousry et al ., ). All patients underwent aortic valve and/or aortic surgery between February 2007 and December 2008 within the Advanced Study of Aortic Pathology (ASAP), a prospective single‐centre trial performed at the Karolinska University Hospital, Stockholm, Sweden.…”

“…We used a previously proposed semi‐quantitative 5‐grade scoring system for visual assessment of the degree of AVC for echocardiographic images and for surgical scoring (Yousry et al ., ). The system scale ranged from 1 to 5 where normal and non‐thickened valves were classified as grade ‘1’; thickened non‐calcified valves as ‘2’; mildly calcified valves (<1/3 of the valve leaflet area highly echogenic) as ‘3’; moderately calcified valves (1/3‐2/3 of the area) as ‘4’ and severely calcified valves (>2/3 of the area) as ‘5’.…”

“…Quantification of AVC using different imaging modalities, such as computed tomography (CT), transthoracic echocardiography (TTE) (Rosenhek et al ., , ; Corciu et al ., ) and transoesophageal echocardiography (TEE) (Colli et al ., ), has recently gained much scientific interest. Different scoring systems and quantitative measures have been proposed (Palmiero et al ., ; Colli et al ., ; Yousry et al ., ). Although it is known that TEE is superior to TTE in diagnosing complications of infective endocarditis (Griffin et al ., ) and evaluation of valvular regurgitation (Ward, ), left ventricular outflow tract dimensions (Shiran et al ., ) and valve type (Espinal et al ., ; Alegret et al ., ), the accuracy of TEE for the assessment of AVC has so far not been compared with intra‐operative evaluation.…”

Quantification of Calcium Amount in a New Experimental Model: A Comparison between Ultrasound and Computed Tomography

“…However, no histological nor CT calcium measurement was objectively performed. [ 33 ] In our study, we therefore sought to develop a robust and objective US method for calcium quantification and compare it to CT, a technique that is known to quantify calcium in a reliable and reproducible way. By using both short and long axis frames, instead of using one still frame, we obtained a more reliable assessment of the calcification.…”

Elastic Properties of the Descending Aorta in Patients with a Bicuspid or Tricuspid Aortic Valve and Aortic Valvular Disease

“…On the other hand, TEE can picture the moving valve during a cardiac cycle. Histopathological examinations of valve morphology would have been favorable [121], but this was not possible as the explanted valves were used for other analyses [122,123]. Overall, there was good agreement between TEE and the surgical classification (sensitivity 92% and specificity 94 % with a kappa value of 0.86) [124].…”