Indexed Aortic Valve Calcium Volume by Computed Tomography Angiography in Patients With Aortic Stenosis

IF 15.2 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging Pub Date : 2026-02-01 Epub Date: 2025-10-25 DOI:10.1016/j.jcmg.2025.09.013

Jolien Geers MD , Neil Craig MD , Kajetan Grodecki MD, PhD , Maria Lembo MD, PhD , Shruti S. Joshi MD, PhD , Trisha Singh MD, PhD , Rong Bing MD, PhD , Jacek Kwieciński MD, PhD , Lorenzo Carnevale PhD , Dorien Kimenai PhD , Soongu Kwak MD, PhD , Seung-Pyo Lee MD, PhD , Kush Patel MD , Thomas Treibel MD, PhD , Aroa Ruiz Muñoz MS , Jose F. Rodriguez Palomares MD, PhD , Jae-Kwan Song MD, PhD , Marie-Annick Clavel DVM, PhD , Pamela Piña MD , Daniel Lorenzatti MD , Marc R. Dweck MD, PhD

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引用次数: 0

Abstract

Background

Calcium scoring from noncontrast computed tomography (CT) is used clinically to adjudicate aortic stenosis severity in patients with discordant echocardiography.

Objectives

The aim of this study was to investigate whether quantification of aortic valve calcium volume from computed tomography angiography (CTA) can provide robust diagnostic discrimination of disease severity and inform risk stratification of patients with aortic stenosis.

Methods

Patients with mild to severe aortic stenosis who underwent concurrent CTA and echocardiography were included in a retrospective international multicenter observational cohort study. Accuracy of aortic valve calcium volume to diagnose severe aortic stenosis in patients with concordant disease on echocardiography was assessed. Association of aortic valve calcium volume with the incidence of aortic valve replacement or all-cause death was investigated.

Results

The study included 1,521 patients (mean age: 74 ± 10 years; 44% female; median peak aortic jet velocity: 3.8 m/s [Q1-Q3: 3.1-4.5 m/s]). Indexed aortic valve calcium volume correlated with peak aortic jet velocity (ρ = 0.723; P < 0.001) and noncontrast CT calcium score (ρ = 0.896; P < 0.001). In the derivation cohort (n = 689), sex-specific thresholds for indexed calcium volume (men: 122 mm³/cm²; women: 61 mm³/cm²) provided excellent diagnostic discrimination for severe aortic stenosis (C-statistic: 0.900 for men; 0.926 for women). Similar diagnostic discrimination was observed in the validation cohort (n = 459; C-statistic: 0.933 for men; 0.944 for women). Clinical outcomes were available in 711 patients (25% with discordant echocardiography), with 249 reaching the primary endpoint after 26 months (Q1-Q3: 12-53 months). Indexed calcium volume thresholds were independently associated with aortic valve replacement or all-cause mortality in both the cohort as a whole (HR: 2.01 [95% CI: 1.30-3.10]; P < 0.01) and those with discordant echocardiography (HR: 1.58 [95% CI: 1.01-2.44]).

Conclusions

In patients with aortic stenosis, indexed aortic valve calcium volume from CTA provides accurate discrimination of disease severity and additive prognostic information. This technique can be easily applied to patients undergoing CTA for transcatheter aortic valve replacement or coronary artery evaluation without the need for a separate noncontrast CT scan.

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主动脉狭窄患者的计算机断层血管成像主动脉瓣钙容量索引：一项国际多中心队列研究的结果。

背景：非对比计算机断层扫描（CT）的钙评分在临床上用于判断超声心动图不一致患者主动脉狭窄的严重程度。目的：本研究的目的是探讨计算机断层血管造影（CTA）对主动脉瓣钙容量的量化是否能提供对疾病严重程度的有力诊断，并为主动脉瓣狭窄患者的风险分层提供信息。方法一项回顾性国际多中心观察队列研究纳入了同时进行CTA和超声心动图检查的轻度至重度主动脉瓣狭窄患者。评价超声心动图上主动脉瓣钙容量诊断重度主动脉狭窄的准确性。研究了主动脉瓣钙容量与主动脉瓣置换术或全因死亡发生率的关系。结果共纳入1521例患者，平均年龄74±10岁，女性44%，主动脉喷射速度中位数峰值为3.8 m/s [Q1-Q3: 3.1-4.5 m/s]。主动脉瓣指数化钙容量与峰值主动脉射流速度（ρ = 0.723, P < 0.001）和CT造影钙评分（ρ = 0.896, P < 0.001）相关。在衍生队列（n = 689）中，指数钙容量的性别特异性阈值（男性：122 mm3/cm2；女性：61 mm3/cm2）提供了对严重主动脉狭窄的良好诊断鉴别（c统计量：男性0.900；女性0.926）。在验证队列中观察到类似的诊断歧视（n = 459； c统计量：男性0.933；女性0.944）。711例患者的临床结果（25%超声心动图不一致），249例在26个月后达到主要终点（Q1-Q3: 12-53个月）。在整个队列中，指数钙容量阈值与主动脉瓣置换术或全因死亡率独立相关（HR: 2.01 [95% CI: 1.30-3.10]; P < 0.01），超声心动图不一致者（HR: 1.58 [95% CI: 1.01-2.44]）。结论在主动脉瓣狭窄患者中，CTA指数主动脉瓣钙容量可准确区分病情严重程度和附加预后信息。这项技术可以很容易地应用于接受CTA的经导管主动脉瓣置换术或冠状动脉评估的患者，而无需单独进行非对比CT扫描。

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

JACC. Cardiovascular imaging CARDIAC & CARDIOVASCULAR SYSTEMS-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

24.90

自引率

5.70%

发文量

330

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Imaging, part of the prestigious Journal of the American College of Cardiology (JACC) family, offers readers a comprehensive perspective on all aspects of cardiovascular imaging. This specialist journal covers original clinical research on both non-invasive and invasive imaging techniques, including echocardiography, CT, CMR, nuclear, optical imaging, and cine-angiography. JACC. Cardiovascular imaging highlights advances in basic science and molecular imaging that are expected to significantly impact clinical practice in the next decade. This influence encompasses improvements in diagnostic performance, enhanced understanding of the pathogenetic basis of diseases, and advancements in therapy. In addition to cutting-edge research,the content of JACC: Cardiovascular Imaging emphasizes practical aspects for the practicing cardiologist, including advocacy and practice management.The journal also features state-of-the-art reviews, ensuring a well-rounded and insightful resource for professionals in the field of cardiovascular imaging.