Sensitivity and specificity of two-dimensional echocardiography in the detection of valvular calcification

To test the ultrasonic method for detecting valvular calcifications, two-dimensional echocardiograms and 35-mm cinefluorograms recorded in 113 elderly men were compared. Four views of the heart were filmed with image intensification. Valvular opacifications 1.5 mm or more in diameter were considered to be calcium and served as the standards. From parasternal views the brightness of valvular echoes was compared to echoes of the aortic wall by incremental rejection. Valvular echoes persisting as long as or beyond suppression of aortic root echoes were called positive for calcium. In half of the subjects, fluorographic studies disclosed valvular calcium, of which 67 percent was graded minimum. Echocardiographic sensitivity for detecting calcium in both the mitral anulus and aortic valve was 76 percent; specificity was 89 to 94 percent. Detection in the mitral leaflets was low and due to the smallness of the target and high sensitivity of the standard. Thus, an easily performed ultrasonic technique can screen moderate calcification of the mitral annulus and aortic valve with a predictive accuracy of 80 percent.