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Evaluation and Clinical Implications of Aortic Valve Calcification Measured by Electron-Beam Computed Tomography

Evaluation and Clinical Implications of Aortic Valve Calcification Measured by Electron-Beam Computed Tomography,David Messika-Zeitoun,Marie-Christine

Evaluation and Clinical Implications of Aortic Valve Calcification Measured by Electron-Beam Computed Tomography   (Citations: 27)
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Background—Electron-beam computed tomography (EBCT) is used to measure coronary calcification but not for aortic valve calcification (AVC). Its accuracy, association with aortic stenosis (AS) severity, and diagnostic and prognostic value with respect to AVC are unknown. Methods and Results—In 30 explanted aortic valves, the AVC score by EBCT (11251294 Agatston units (AU)) showed a strong linear correlation (r0.96, P0.0001) with valvular calcium weight (653748 mg) by pathology that allowed estimation of calcium weight as AVC score/1.7, with a small standard error of the estimate (53 mg). In 100 consecutive clinical patients, we measured AVC by EBCT and AS severity by echocardiographic aortic valve area (AVA). The AVC score was 13161749 AU (range 0 to 7226 AU). Intraobserver and interobserver variabilities were excellent (44% and 410%, respectively). AVC and AVA were strongly associated (r0.79, P0.0001) but had a curvilinear relationship that suggested that AVC and AVA provide complementary information. AVC score1100 AU provided 93% sensitivity and 82% specificity for diagnosis of severe AS (AVA 1c m 2), with a receiver operator characteristic curve area of 0.89. AVC assessment by echocardiography was often more severe than by EBCT (P0.0001). During follow-up, 22 patients either died, developed heart failure, or required surgery. With adjustment for age, sex, symptoms, ejection fraction, and AVA, the AVC score was independently predictive of event-free survival (risk ratio 1.06 per 100-AU increment (1.02 to 1.10), P0.001), even after adjustment for echocardiographic calcifications. Conclusions—AVC is accurately and reproducibly measured by EBCT and shows a strong association and diagnostic value for severe AS. The curvilinear relationship between AVC and AVA suggests these measures are complementary, and indeed, AVC provides independent outcome information. Thus, AVC is an important measurement in the evaluation of patients with AS. (Circulation. 2004;110:356-362.)
Published in 2010.
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    • ...Aortic valve calcification (AVC) is the leading process to aortic valve stenosis. Measurement of the degree of AVC using electron beam computed tomography (EBCT) has previously been validated as a complementary method for the evaluation of AS severity....

    Caroline Cueffet al. Measurement of aortic valve calcification using multislice computed to...

    • ...In addition, quantification of aortic valve calcification with CT represents a complementary information to the severity of AS and provides independent outcome information for these patients [34]...

    Paul Stolzmannet al. Remodelling of the aortic root in severe tricuspid aortic stenosis: im...

    • ...Thus, exercise stress testing seems to be a reliable method to guide clinical decision-making in patients with asymptomatic aortic stenosis. Assessment of the extent of aortic valvular calcification has also been used for risk stratification. Quantitative assessment by electron beam computed tomography (EBCT) seems to have value in predicting event-free survival....

    R Goelet al. Valvular regurgitation and stenosis: when is surgery required?

    • ...Over the recent years, a number of papers have addressed the use of MDCT in patients with AS. The ability of the technique to detect and quantify calcifications was the first reason for its application to calcific AS. Indeed, quantification of valvular calcification first by electron-beam computed tomography (EBCT) (17), and later on by MDCT (18, 19) has been well validated by studying patients prior to surgery and comparing the results ...

    ALI YOUSEFF DIABet al. Aortic stenosis and role of multi-detector row computed tomography in ...

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