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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...
Autores principales: | , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2021
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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. |
format | Online Article Text |
id | pubmed-8600609 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
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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