Contrast-enhanced computed tomography assessment of aortic stenosis.

Auteur(s): Timothy Robert, Graham Cartlidge; Bing, Rong; Kwiecinski, Jacek; Guzzetti, Ezequiel; Pawade, Tania; Doris, Mhairi K; Adamson, Philip D; Massera, Daniele; Lembo, Maria; Peeters, Frederique E. C. M.; Couture, Christian; Berman, Daniel S; Dey, Damini; Slomka, Piotr; Pibarot, Philippe; Newby, David E; Clavel, Marie-Annick; Dweck, Marc R
Résumé: Abstract 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.
Type de document: Article de recherche
Date de publication: 29 janvier 2021
Date de la mise en libre accès: 10 juin 2021
Version du document: VoR
Licence Creative Commons: https://creativecommons.org/licenses/by/4.0
Lien permanent: http://hdl.handle.net/20.500.11794/69350
Ce document a été publié dans: Valvular heart disease, 1-7 (2021)
https://doi.org/10.1136/heartjnl-2020-318556
Autre version disponible: 10.1136/heartjnl-2020-318556
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Collection :Articles publiés dans des revues avec comité de lecture

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