Related Experiment Video
Updated: Jun 25, 2025
Investigating Aortic Valve Calcification via Isolation and Culture of T Lymphocytes using Feeder Cells from Irradiated Buffy Coat
Published on: February 4, 2021
Aortic Valve Calcification Density Measured by MDCT in the Assessment of Aortic Stenosis Severity
Andréanne Powers1, Mulham Ali2, Nicolas Lavoie1
1Institut Universitaire de Cardiologie et Pneumologie de Québec (Quebec Heart & Lung Institute), Université Laval, Canada (A.P., N.L., N.S.B.M., L.T., C.R., M.-A.C.).
Insights
Aortic valve calcification (AVC) indexation using computed tomography (AVCdCT) is superior to echocardiography (AVCdEcho) for assessing aortic stenosis severity and predicting mortality. AVCdCT should be used when echocardiography is inconclusive.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Aortic valve calcification (AVC) indexation to the aortic annulus (AA) area via Doppler echocardiography (AVCdEcho) offers prognostic value in aortic stenosis (AS).
- The utility of AVC indexation using multidetector computed tomography (AVCdCT) for AS assessment remains unevaluated.
Purpose of the Study:
- To compare AVC, AVCdCT, and AVCdEcho in terms of hemodynamic correlations and clinical outcomes in patients with AS.
- To evaluate the prognostic capability of AVCdCT in predicting mortality in AS patients.
Main Methods:
- Retrospective analysis of 889 patients with calcific AS who underwent both Doppler echocardiography and multidetector computed tomography.
- Measurement of AA by both imaging modalities; establishment of AVCdCT severity thresholds using ROC curve analysis stratified by sex.
- Primary endpoint was all-cause mortality; secondary endpoint was survival under medical treatment.
Main Results:
- AVCdCT demonstrated stronger correlations with AS gradient/velocity compared to AVC and AVCdEcho (P≤0.005).
- Established AVCdCT thresholds for severe AS: 334 AU/cm² for women and 467 AU/cm² for men.
- AVCdCT significantly outperformed AVC and AVCdEcho in predicting all-cause mortality and survival under medical treatment in multivariate analyses (P<0.001).
Conclusions:
- AVCdCT is equivalent or superior to AVC and AVCdEcho for AS severity assessment and mortality prediction.
- Recommended use of AVCdCT for evaluating AS severity, particularly in cases with inconclusive echocardiographic findings.
- Proposed AVCdCT thresholds of 300 AU/cm² for women and 500 AU/cm² for men to identify severe AS, warranting further validation.
Background:
Aortic valve calcification (AVC) indexation to the aortic annulus (AA) area measured by Doppler echocardiography (AVCdEcho) provides powerful prognostic information in patients with aortic stenosis (AS). However, the indexation by AA measured by multidetector computed tomography (AVCdCT) has never been evaluated. The aim of this study was to compare AVC, AVCdCT, and AVCdEcho with regard to hemodynamic correlations and clinical outcomes in patients with AS.
Methods:
Data from 889 patients, mainly White, with calcific AS who underwent Doppler echocardiography and multidetector computed tomography within the same episode of care were retrospectively analyzed. AA was measured both by Doppler echocardiography and multidetector computed tomography. AVCdCT severity thresholds were established using receiver operating characteristic curve analyses in men and women separately. The primary end point was the occurrence of all-cause mortality.
Results:
Correlations between gradient/velocity and AVCd were stronger (both P≤0.005) using AVCdCT (r=0.68, P<0.001 and r=0.66, P<0.001) than AVC (r=0.61, P<0.001 and r=0.60, P<0.001) or AVCdEcho (r=0.61, P<0.001 and r=0.59, P<0.001). AVCdCT thresholds for the identification of severe AS were 334 Agatston units (AU)/cm2 for women and 467 AU/cm2 for men. On a median follow-up of 6.62 (6.19-9.69) years, AVCdCT ratio was superior to AVC ratio and AVCdEcho ratio to predict all-cause mortality in multivariate analyses (hazard ratio [HR], 1.59 [95% CI, 1.26-2.00]; P<0.001 versus HR, 1.53 [95% CI, 1.11-1.65]; P=0.003 versus HR, 1.27 [95% CI, 1.11-1.46]; P<0.001; all likelihood test P≤0.004). AVCdCT ratio was superior to AVC ratio and AVCdEcho ratio to predict survival under medical treatment in multivariate analyses (HR, 1.80 [95% CI, 1.27-1.58]; P<0.001 compared with HR, 1.55 [95% CI, 1.13-2.10]; P=0.007; HR, 1.28 [95% CI, 1.03-1.57]; P=0.01; all likelihood test P<0.03). AVCdCT ratio predicts mortality in all subgroups of patients with AS.
Conclusions:
AVCdCT appears to be equivalent or superior to AVC and AVCdEcho to assess AS severity and predict all-cause mortality. Thus, it should be used to evaluate AS severity in patients with nonconclusive echocardiographic evaluations with or without low-flow status. AVCdCT thresholds of 300 AU/cm2 for women and 500 AU/cm2 for men seem to be appropriate to identify severe AS. Further studies are needed to validate these thresholds, especially in diverse populations.
