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Contrast-enhanced computed tomography assessment of aortic stenosis

OBJECTIVES: Non-contrast CT aortic valve calcium scoring ignores the contribution of valvular fibrosis in aortic stenosis. We assessed aortic valve calcific and non-calcific disease using contrast-enhanced CT. METHODS: This was a post hoc analysis of 164 patients (median age 71 (IQR 66–77) years, 78...

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Autores principales: Cartlidge, Timothy RG, Bing, Rong, Kwiecinski, Jacek, Guzzetti, Ezequiel, Pawade, Tania A, Doris, Mhairi K, Adamson, Philip D, Massera, Daniele, Lembo, Maria, Peeters, Frederique E C M, Couture, Christian, Berman, Daniel S, Dey, Damini, Slomka, Piotr, Pibarot, Philippe, Newby, David E, Clavel, Marie-Annick, Dweck, Marc R
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8600609/
https://www.ncbi.nlm.nih.gov/pubmed/33514522
http://dx.doi.org/10.1136/heartjnl-2020-318556
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author Cartlidge, Timothy RG
Bing, Rong
Kwiecinski, Jacek
Guzzetti, Ezequiel
Pawade, Tania A
Doris, Mhairi K
Adamson, Philip D
Massera, Daniele
Lembo, Maria
Peeters, Frederique E C M
Couture, Christian
Berman, Daniel S
Dey, Damini
Slomka, Piotr
Pibarot, Philippe
Newby, David E
Clavel, Marie-Annick
Dweck, Marc R
author_facet Cartlidge, Timothy RG
Bing, Rong
Kwiecinski, Jacek
Guzzetti, Ezequiel
Pawade, Tania A
Doris, Mhairi K
Adamson, Philip D
Massera, Daniele
Lembo, Maria
Peeters, Frederique E C M
Couture, Christian
Berman, Daniel S
Dey, Damini
Slomka, Piotr
Pibarot, Philippe
Newby, David E
Clavel, Marie-Annick
Dweck, Marc R
author_sort Cartlidge, Timothy RG
collection PubMed
description OBJECTIVES: Non-contrast CT aortic valve calcium scoring ignores the contribution of valvular fibrosis in aortic stenosis. We assessed aortic valve calcific and non-calcific disease using contrast-enhanced CT. METHODS: This was a post hoc analysis of 164 patients (median age 71 (IQR 66–77) years, 78% male) with aortic stenosis (41 mild, 89 moderate, 34 severe; 7% bicuspid) who underwent echocardiography and contrast-enhanced CT as part of imaging studies. Calcific and non-calcific (fibrosis) valve tissue volumes were quantified and indexed to annulus area, using Hounsfield unit thresholds calibrated against blood pool radiodensity. The fibrocalcific ratio assessed the relative contributions of valve fibrosis and calcification. The fibrocalcific volume (sum of indexed non-calcific and calcific volumes) was compared with aortic valve peak velocity and, in a subgroup, histology and valve weight. RESULTS: Contrast-enhanced CT calcium volumes correlated with CT calcium score (r=0.80, p<0.001) and peak aortic jet velocity (r=0.55, p<0.001). The fibrocalcific ratio decreased with increasing aortic stenosis severity (mild: 1.29 (0.98–2.38), moderate: 0.87 (1.48–1.72), severe: 0.47 (0.33–0.78), p<0.001) while the fibrocalcific volume increased (mild: 109 (75–150), moderate: 191 (117–253), severe: 274 (213–344) mm(3)/cm(2)). Fibrocalcific volume correlated with ex vivo valve weight (r=0.72, p<0.001). Compared with the Agatston score, fibrocalcific volume demonstrated a better correlation with peak aortic jet velocity (r=0.59 and r=0.67, respectively), particularly in females (r=0.38 and r=0.72, respectively). CONCLUSIONS: Contrast-enhanced CT assessment of aortic valve calcific and non-calcific volumes correlates with aortic stenosis severity and may be preferable to non-contrast CT when fibrosis is a significant contributor to valve obstruction.
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spelling pubmed-86006092021-12-02 Contrast-enhanced computed tomography assessment of aortic stenosis Cartlidge, Timothy RG Bing, Rong Kwiecinski, Jacek Guzzetti, Ezequiel Pawade, Tania A Doris, Mhairi K Adamson, Philip D Massera, Daniele Lembo, Maria Peeters, Frederique E C M Couture, Christian Berman, Daniel S Dey, Damini Slomka, Piotr Pibarot, Philippe Newby, David E Clavel, Marie-Annick Dweck, Marc R Heart Valvular Heart Disease OBJECTIVES: Non-contrast CT aortic valve calcium scoring ignores the contribution of valvular fibrosis in aortic stenosis. We assessed aortic valve calcific and non-calcific disease using contrast-enhanced CT. METHODS: This was a post hoc analysis of 164 patients (median age 71 (IQR 66–77) years, 78% male) with aortic stenosis (41 mild, 89 moderate, 34 severe; 7% bicuspid) who underwent echocardiography and contrast-enhanced CT as part of imaging studies. Calcific and non-calcific (fibrosis) valve tissue volumes were quantified and indexed to annulus area, using Hounsfield unit thresholds calibrated against blood pool radiodensity. The fibrocalcific ratio assessed the relative contributions of valve fibrosis and calcification. The fibrocalcific volume (sum of indexed non-calcific and calcific volumes) was compared with aortic valve peak velocity and, in a subgroup, histology and valve weight. RESULTS: Contrast-enhanced CT calcium volumes correlated with CT calcium score (r=0.80, p<0.001) and peak aortic jet velocity (r=0.55, p<0.001). The fibrocalcific ratio decreased with increasing aortic stenosis severity (mild: 1.29 (0.98–2.38), moderate: 0.87 (1.48–1.72), severe: 0.47 (0.33–0.78), p<0.001) while the fibrocalcific volume increased (mild: 109 (75–150), moderate: 191 (117–253), severe: 274 (213–344) mm(3)/cm(2)). Fibrocalcific volume correlated with ex vivo valve weight (r=0.72, p<0.001). Compared with the Agatston score, fibrocalcific volume demonstrated a better correlation with peak aortic jet velocity (r=0.59 and r=0.67, respectively), particularly in females (r=0.38 and r=0.72, respectively). CONCLUSIONS: Contrast-enhanced CT assessment of aortic valve calcific and non-calcific volumes correlates with aortic stenosis severity and may be preferable to non-contrast CT when fibrosis is a significant contributor to valve obstruction. BMJ Publishing Group 2021-12 2021-01-29 /pmc/articles/PMC8600609/ /pubmed/33514522 http://dx.doi.org/10.1136/heartjnl-2020-318556 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Valvular Heart Disease
Cartlidge, Timothy RG
Bing, Rong
Kwiecinski, Jacek
Guzzetti, Ezequiel
Pawade, Tania A
Doris, Mhairi K
Adamson, Philip D
Massera, Daniele
Lembo, Maria
Peeters, Frederique E C M
Couture, Christian
Berman, Daniel S
Dey, Damini
Slomka, Piotr
Pibarot, Philippe
Newby, David E
Clavel, Marie-Annick
Dweck, Marc R
Contrast-enhanced computed tomography assessment of aortic stenosis
title Contrast-enhanced computed tomography assessment of aortic stenosis
title_full Contrast-enhanced computed tomography assessment of aortic stenosis
title_fullStr Contrast-enhanced computed tomography assessment of aortic stenosis
title_full_unstemmed Contrast-enhanced computed tomography assessment of aortic stenosis
title_short Contrast-enhanced computed tomography assessment of aortic stenosis
title_sort contrast-enhanced computed tomography assessment of aortic stenosis
topic Valvular Heart Disease
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8600609/
https://www.ncbi.nlm.nih.gov/pubmed/33514522
http://dx.doi.org/10.1136/heartjnl-2020-318556
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