Contrast-enhanced computed tomography assessment of aortic stenosis
Timothy Rg Cartlidge1, Rong Bing2, Jacek Kwiecinski3
1Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK.
Heart (British Cardiac Society)
|January 30, 2021
Summary
Contrast-enhanced CT can assess both calcific and non-calcific aortic valve disease, offering a more comprehensive view than calcium scoring alone. This method better correlates with aortic stenosis severity and patient outcomes.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Cardiac Surgery
Background:
- Non-contrast CT calcium scoring for aortic valve stenosis (AS) overlooks valvular fibrosis.
- Accurate assessment of AS requires evaluating both calcific and non-calcific components.
- Contrast-enhanced CT offers a potential method for quantifying these components.
Purpose of the Study:
- To assess aortic valve calcific and non-calcific disease using contrast-enhanced CT.
- To compare contrast-enhanced CT findings with AS severity and clinical outcomes.
- To evaluate the utility of contrast-enhanced CT in cases where fibrosis significantly contributes to obstruction.
Main Methods:
- Post hoc analysis of 164 patients with AS who underwent echocardiography and contrast-enhanced CT.
- Quantification of calcific and non-calcific (fibrosis) valve tissue volumes, indexed to annulus area.
- Comparison of fibrocalcific volume and ratio with aortic valve peak velocity, histology, and valve weight.
Main Results:
- Contrast-enhanced CT calcium volumes correlated strongly with CT calcium score (r=0.80) and peak aortic jet velocity (r=0.55).
- Fibrocalcific ratio decreased with increasing AS severity, while fibrocalcific volume increased.
- Fibrocalcific volume showed a better correlation with peak aortic jet velocity (r=0.67) than the Agatston score (r=0.59), especially in females.
Conclusions:
- Contrast-enhanced CT assessment of aortic valve calcific and non-calcific volumes correlates with AS severity.
- This method may be superior to non-contrast CT when fibrosis is a major contributor to valve obstruction.
- Contrast-enhanced CT provides a more comprehensive evaluation of aortic valve disease.
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