Aortic Valve Calcium Score Quantification by Contrast Cardiac CT: Correlations With Echocardiography and Optimal Thresholds.

IF 6.5 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation: Cardiovascular Imaging Pub Date : 2025-05-16 DOI:10.1161/CIRCIMAGING.124.017373

Tiffany Dong, Elio Haroun, Aro Daniela Arockiam, Rishabh Khurana, Joseph El Dahdah, Ankit Agrawal, Yuichiro Okushi, David Moros, Kashyap Bodi, Ushasi Saraswati, Mohammad Alamer, Abdelrahman Abushouk, Agam Bansal, Serge Harb, Zoran Popovic, Leonardo Rodriguez, Rishi Puri, Grant Reed, Amar Krishnaswamy, Brian Griffin, Samir Kapadia, Tom Kai Ming Wang

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引用次数: 0

Abstract

Background: Aortic valve calcium score (AVCa) measured on noncontrast computed tomography (CT) is well-established for grading aortic stenosis (AS) severity. However, thresholds for AVCa measured on contrast CT remain uncertain. We evaluated correlations, associated factors, and severity thresholds of AVCa measured on contrast CT against transthoracic echocardiography (TTE) measures of AS.

Methods: Patients with native AS undergoing transcatheter aortic valve replacement evaluation from 2019 to 2020 who underwent TTE and contrast-enhanced CT were retrospectively studied (n=1035, age 79±9 years, 429 (41.5%) women, 906 (87.5%) severe and 129 (12.5%) moderate AS by TTE). AVCa was measured using the modified Agatston method with the minimum threshold of 4 SD above the mean ascending aorta blood pool Hounsfield units. Receiver-operating characteristics analysis and Youden index were used to define sex-specific optimal AVCa thresholds for identifying severe AS defined by TTE (aortic valve area by continuity equation ≤1.0 cm²) in the derivation cohort and assessed when applied to the validation cohort.

Results: Mean aortic valve area on TTE was 0.79±0.21 cm², while mean AVCa score, volume, and mass were 2152±1102 modified AU, 1853±1592 mm³, and 673±485 mg, respectively. Multivariable linear regression identified women to be associated with lower AVCa (β-coefficient, -358), while chronic kidney disease was associated with a higher AVCa (β-coefficient, 171). Optimal severe AS thresholds of ≥1840 modified AU for men and ≥1430 modified AU for women were determined, with area under curve (95% CIs) and sensitivities/specificities of 0.809 (0.749-0.869, 71.3%, 82.2%) for men and 0.822 (0.751-0.892), 73.4%/78.9% for women in the derivation cohort, and 0.830 (0.786-0.875), 75.9%/87.5% for men and 0.780 (0.670-0.890), 77.5%/71.4% for women in the validation cohort.

Conclusions: AVCa by contrast CT is a useful tool for identifying severe AS by TTE, with sex-specific thresholds for severe AS identified. Further studies are necessary to externally validate our findings and evaluate their prognostic significance.

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心脏CT造影主动脉瓣钙评分量化：与超声心动图和最佳阈值的相关性。

背景：在非对比计算机断层扫描（CT）上测量主动脉瓣钙评分（AVCa）是公认的主动脉瓣狭窄（AS）严重程度分级的方法。然而，在对比CT上测量AVCa的阈值仍然不确定。我们评估了对比CT测量的AVCa与经胸超声心动图（TTE）测量AS的相关性、相关因素和严重阈值。方法：回顾性研究2019 - 2020年接受经导管主动脉瓣置换术评估并接受TTE和增强CT检查的原发性AS患者（n=1035例，年龄79±9岁，429例（41.5%）女性，906例（87.5%）重度AS和129例（12.5%）中度AS）。AVCa采用改进的Agatston法测量，最小阈值比升主动脉血池平均Hounsfield单位高4 SD。采用受试者操作特征分析和约登指数来确定衍生队列中由TTE（连续性方程主动脉瓣面积≤1.0 cm2）定义的严重AS的性别特异性最佳AVCa阈值，并在应用于验证队列时进行评估。结果：TTE主动脉瓣面积平均为0.79±0.21 cm2， AVCa评分、体积和质量平均分别为2152±1102改良AU、1853±1592 mm3和673±485 mg。多变量线性回归发现女性与较低的AVCa相关（β-系数，-358），而慢性肾脏疾病与较高的AVCa相关（β-系数，171）。确定了男性≥1840改良AU和女性≥1430改良AU的最佳严重AS阈值，衍生队列中男性的曲线下面积（95% ci）和敏感性/特异性分别为0.809（0.749-0.869,71.3%,82.2%）和0.822(0.751-0.892),73.4%/78.9%；验证队列中男性为0.830(0.786-0.875),75.9%/87.5%，女性为0.780(0.670-0.890),77.5%/71.4%。结论：相比之下，AVCa CT是通过TTE识别严重AS的有用工具，具有性别特异性阈值。需要进一步的研究来外部验证我们的发现并评估其预后意义。

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.