Characterization of Aortic Valve Stenosis by CT Angiography in a Diverse US Cohort.

IF 7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation: Cardiovascular Imaging Pub Date : 2025-06-01 Epub Date: 2025-05-09 DOI:10.1161/CIRCIMAGING.124.017858

Daniel Lorenzatti, Annalisa Filtz, Pamela Pina, Jolien Geers, Jake Gilman, Jonathan Daich, Paul Ippolito, Abdullah Aftab, Aldo L Schenone, Carlos A Gongora, Justin Johannesen, Andrea Scotti, Edwin C Ho, Mario J Garcia, Azeem Latib, Carlos J Rodriguez, Daniel S Berman, Marie-Annick Clavel, Philippe Pibarot, Robert O Bonow, Piotr J Slomka, Marc R Dweck, Damini Dey, Leandro Slipczuk

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引用次数: 0

Abstract

Background: Aortic stenosis (AS) involves calcific and fibrotic degeneration of the valve tissue. The only noninvasive method for evaluating both processes is contrast-enhanced computed tomography angiography. We aimed to explore the differences in aortic valve (AV) tissue composition across sex, race/ethnicity, and AS hemodynamic phenotype in US patients referred for transcatheter AV replacement planning.

Methods: We retrospectively analyzed symptomatic patients with AS who underwent computed tomography angiography for transcatheter AV replacement planning between 2015 and 2022. Using semi-automated software, we quantified the AV tissue composition by fibrotic, calcific, and fibro-calcific volumes, and the fibro-calcific ratio (fibrotic/calcific volume) as a measure of valve phenotype.

Results: The study included 651 patients (mean age 84 years; 55% women) with 38% non-Hispanic (NH)-White, 27% Hispanic, and 13% NH-Black. Women had lower fibro-calcific (230 versus 293 mm³/cm²; P<0.001) and calcific volumes (85 versus 149 mm³/cm²; P<0.001), and higher fibro-calcific ratio (1.47 versus 0.83; P<0.001). No differences were observed in the fibrotic volumes (P=0.805). NH-White women had higher fibro-calcific (256 mm³/cm², P=0.002) and fibrotic volumes (145 mm³/cm²; P<0.001), and fibro-calcific ratio (1.57; P=0.01) compared with Hispanic and NH-Black women. No differences were found among men. High-gradient AS had higher fibro-calcific (295 versus 219 mm³/cm²; P<0.001) and calcific volumes (148 versus 88 mm³/cm²; P<0.001), and a lower fibro-calcific ratio (0.90 versus 1.45; P<0.001), although no difference in fibrotic volume (P=0.099) compared with low-gradient AS.

Conclusions: Phenotypic differences in computed tomography angiography valve tissue composition exist in patients with AS referred for transcatheter AV replacement, with women and low-gradient AS showing a proportionally more fibrotic phenotype. NH-White women have the highest fibrotic tissue composition, and no differences are evident among men.

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CT血管造影对美国不同人群主动脉瓣狭窄的表征。

背景：主动脉瓣狭窄（AS）涉及瓣膜组织的钙化和纤维化变性。唯一评估这两个过程的无创方法是对比增强计算机断层血管造影。我们的目的是探讨经导管主动脉瓣置换术计划的美国患者中，不同性别、种族/民族和AS血流动力学表型的主动脉瓣组织组成的差异。方法：我们回顾性分析了2015年至2022年间接受计算机断层血管造影进行经导管房室置换术计划的有症状的AS患者。使用半自动软件，我们通过纤维化、钙化和纤维钙化体积量化了AV组织组成，并将纤维钙化比（纤维化/钙化体积）作为瓣膜表型的测量指标。结果：研究纳入651例患者(平均年龄84岁；55%为女性)，38%为非西班牙裔（NH）白人，27%为西班牙裔，13%为NH-黑人。女性的纤维钙化水平较低(230比293 mm³/cm²；PPPP = 0.805)。NH-White女性有较高的纤维钙化（256 mm³/cm²，P=0.002）和纤维化体积(145 mm³/cm²；PP=0.01)。在男性中没有发现差异。高梯度AS具有更高的纤维钙化(295对219 mm3/cm2；P3 / cm2;PPP=0.099)，与低梯度AS相比。结论：经导管房室置换术的AS患者在计算机断层血管造影瓣膜组织组成上存在表型差异，女性和低梯度AS呈现成比例更多的纤维化表型。NH-White女性的纤维化组织成分最高，在男性中无明显差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Circulation: Cardiovascular Imaging 医学-核医学

CiteScore

6.30

自引率

2.70%

发文量

225

审稿时长

6-12 weeks

期刊介绍： Circulation: Cardiovascular Imaging, an American Heart Association journal, publishes high-quality, patient-centric articles focusing on observational studies, clinical trials, and advances in applied (translational) research. The journal features innovative, multimodality approaches to the diagnosis and risk stratification of cardiovascular disease. Modalities covered include echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging and spectroscopy, magnetic resonance angiography, cardiac positron emission tomography, noninvasive assessment of vascular and endothelial function, radionuclide imaging, molecular imaging, and others. Article types considered by Circulation: Cardiovascular Imaging include Original Research, Research Letters, Advances in Cardiovascular Imaging, Clinical Implications of Molecular Imaging Research, How to Use Imaging, Translating Novel Imaging Technologies into Clinical Applications, and Cardiovascular Images.