RT Journal Article
SR Electronic
T1 Contrast-enhanced computed tomography assessment of aortic stenosis
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1905
OP 1911
DO 10.1136/heartjnl-2020-318556
VO 107
IS 23
A1 Cartlidge, Timothy RG
A1 Bing, Rong
A1 Kwiecinski, Jacek
A1 Guzzetti, Ezequiel
A1 Pawade, Tania A
A1 Doris, Mhairi K
A1 Adamson, Philip D
A1 Massera, Daniele
A1 Lembo, Maria
A1 Peeters, Frederique E C M
A1 Couture, Christian
A1 Berman, Daniel S
A1 Dey, Damini
A1 Slomka, Piotr
A1 Pibarot, Philippe
A1 Newby, David E
A1 Clavel, Marie-Annick
A1 Dweck, Marc R
YR 2021
UL http://heart.bmj.com/content/107/23/1905.abstract
AB Objectives Non-contrast CT aortic valve calcium scoring ignores the contribution of valvular fibrosis in aortic stenosis. We assessed aortic valve calcific and non-calcific disease using contrast-enhanced CT.Methods This was a post hoc analysis of 164 patients (median age 71 (IQR 66–77) years, 78% male) with aortic stenosis (41 mild, 89 moderate, 34 severe; 7% bicuspid) who underwent echocardiography and contrast-enhanced CT as part of imaging studies. Calcific and non-calcific (fibrosis) valve tissue volumes were quantified and indexed to annulus area, using Hounsfield unit thresholds calibrated against blood pool radiodensity. The fibrocalcific ratio assessed the relative contributions of valve fibrosis and calcification. The fibrocalcific volume (sum of indexed non-calcific and calcific volumes) was compared with aortic valve peak velocity and, in a subgroup, histology and valve weight.Results Contrast-enhanced CT calcium volumes correlated with CT calcium score (r=0.80, p<0.001) and peak aortic jet velocity (r=0.55, p<0.001). The fibrocalcific ratio decreased with increasing aortic stenosis severity (mild: 1.29 (0.98–2.38), moderate: 0.87 (1.48–1.72), severe: 0.47 (0.33–0.78), p<0.001) while the fibrocalcific volume increased (mild: 109 (75–150), moderate: 191 (117–253), severe: 274 (213–344) mm3/cm2). Fibrocalcific volume correlated with ex vivo valve weight (r=0.72, p<0.001). Compared with the Agatston score, fibrocalcific volume demonstrated a better correlation with peak aortic jet velocity (r=0.59 and r=0.67, respectively), particularly in females (r=0.38 and r=0.72, respectively).Conclusions Contrast-enhanced CT assessment of aortic valve calcific and non-calcific volumes correlates with aortic stenosis severity and may be preferable to non-contrast CT when fibrosis is a significant contributor to valve obstruction.Data are available upon reasonable request.