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Published on: August 28, 2018
Correlation Between Cardiac Computed Tomography and Histopathology for Evaluating Patients with Aortic Valve Disease
Huitzilihuitl Saucedo-Orozco1, Israel Pérez Torres2, Sergio Andrés Criales Vera3
1Cardioneumology Department, Instituto Nacional de Cardiología "Ignacio Chávez", México City, México.
Insights
Cardiac computed tomography (CT) accurately quantifies aortic valve calcium (AVC) when compared to histopathology. However, AVC severity did not predict mortality after aortic valve replacement surgery.
Area of Science:
- Cardiology
- Radiology
- Pathology
Background:
- Cardiac computed tomography (CT) and Agatston scoring are increasingly used for aortic valve calcium (AVC) evaluation.
- Accurate quantification of AVC is crucial for diagnostic and prognostic purposes.
Purpose of the Study:
- To assess the correlation between cardiac CT-derived Agatston scores and histopathological findings for AVC quantification.
- To investigate the prognostic value of AVC severity on long-term survival after aortic valve replacement.
Main Methods:
- Ninety patients with severe aortic valve dysfunction underwent pre-surgical cardiac CT for Agatston score measurement.
- Native valves were histopathologically examined for qualitative and quantitative calcium analysis.
- Four-year follow-up was conducted post-aortic valve replacement.
Main Results:
- A moderate to high positive correlation was found between Agatston scores and histopathological AVC quantification (rs=0.75, p<0.001).
- Calcium load varied significantly by gender and valve injury type.
- Aortic valve calcium severity did not impact survival post-replacement, unlike left ventricular dysfunction (p=0.003).
Conclusions:
- Cardiac CT Agatston scoring demonstrates a reliable correlation with histopathology for AVC quantification.
- Aortic valve calcification severity is not a predictor of mortality after valve replacement surgery.
Background:
The use of cardiac computed tomography (cardiac CT) and the quantification of the Agatston score for the evaluation of calcium of the aortic valve (AVC) has increased in different clinical contexts for diagnostic and prognostic purposes. This study aims to evaluate the correlation between cardiac CT and histopathology for the quantification of AVC.
Methods:
Ninety patients diagnosed with severe aortic valve dysfunction, of any etiology and regardless of the predominant type of injury, were included. Before the surgical event, a Cardiac CT were performed with Agatston Score measurement. The removed native valve was evaluated by a Pathologist, who provided a qualitative and quantitative evaluation of valve calcium. Calcium density was also analyzed by quantifying the area in pixel units obtained from photomicrographs. Follow-up was performed for four years after the aortic valve replacement.
Results:
Ninety patients were analyzed. The degenerative etiology predominated 63.3% (57 patients). The calcium load was different for the gender (p = 0.01) and type of valve injury (p = 0.0013). There was a positive correlation between the Agatston score, and the percentage of calcium reported by the pathologist in a conventional qualitative way (rs = 0.75, p < 0.001) and between the AVC and the Cote et al. score (rs = 0.77, p < 0.001). There was no difference in survival after aortic valve replacement concerning valve calcium load. Left ventricular dysfunction showed a significant difference in survival (p = 0.003, Log-rank).
Conclusion:
There is a moderately high correlation between the Agatston score quantified by Cardiac CT and the histopathological evaluation. The severity of the calcification did not prove to be a predictor of death in the postsurgical follow-up.
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