Preoperative Computed Tomography Angiography Reveals Leaflet-Specific Calcification and Excursion Patterns in Aortic
Ian Y Chen1,2, Vijay Vedula3, Sachin B Malik4,5
1Stanford Cardiovascular Institute (I.Y.C., N.S., J.C.W.), Stanford University School of Medicine, CA.
Circulation. Cardiovascular Imaging
|December 17, 2021
Summary
Aortic stenosis (AS) calcium scoring overlooks leaflet differences. The noncoronary cusp and right coronary cusp show more calcification, but the left coronary cusp
Area of Science:
- Cardiovascular Imaging
- Biomedical Engineering
- Valvular Heart Disease
Background:
- Computed tomography (CT) calcium scoring for aortic stenosis (AS) does not account for interleaflet variations.
- Understanding these differences is crucial for accurate AS assessment.
Purpose of the Study:
- To investigate the functional implications of interleaflet differences in leaflet characteristics in patients with AS.
- To compare calcification load, appearance, and systolic leaflet excursion among individual aortic valve leaflets.
Main Methods:
- Retrospective review of CT angiograms from 200 male patients with AS and 20 controls.
- Comparison of CT angiography-derived aortic valve leaflet calcification load (AVLCCTA), appearance, and leaflet excursion (LEsys).
- Computer simulations to assess the impact of leaflet excursion differences on aortic valve area.
Main Results:
- The noncoronary cusp (NCC) had the highest AVLCCTA, followed by the left coronary cusp (LCC) and right coronary cusp (RCC).
- LCC exhibited the least systolic leaflet excursion and was more frequently thickened, despite lower calcification.
- Computer simulations showed greater reductions in aortic valve area with NCC and RCC closure compared to LCC.
Conclusions:
- In male patients with AS, NCC and RCC calcification significantly impacts severity.
- LCC's noncalcific thickening and reduced leaflet excursion are critical factors in AS, often underestimated by calcium scoring alone.
Keywords:
aortic valve stenosiscalciumcomputed tomography angiographycomputer simulationtranscatheter aortic valve replacementMore Related Videos
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