Aortic valve calcification density correlated well with mean transvalvular gradient in TAV patients (ρ=0.61) and older BAV patients (ρ=0.55), but not in younger BAV patients (ρ=0.12, p=0.65).
Cohort (n=200)
Does aortic valve anatomy and age affect the correlation between aortic valve calcification density and hemodynamic severity in patients with aortic stenosis?
Aortic valve calcification density correlates well with hemodynamic severity in patients with tricuspid aortic valves and older patients with bicuspid valves, but not in younger patients with bicuspid valves.
Effect estimate: ρ=0.51
p-value: p=<0.0001
OBJECTIVE: To evaluate the effect of age and aortic valve anatomy (tricuspid (TAV) vs bicuspid (BAV) aortic valve) on the relationship between the aortic valve calcification (AVC) and the haemodynamic parameters of aortic stenosis (AS) severity. METHODS: Two hundred patients with AS and preserved left ventricular ejection fraction were prospectively recruited in the PROGRESSA (Metabolic Determinants of the Progression of Aortic Stenosis) study and underwent a comprehensive Doppler echocardiography and multidetector CT (MDCT). Mean transvalvular gradient (MG) measured by Doppler echocardiography was used to assess AS haemodynamic severity and AVC was evaluated by MDCT using the Agatston method and indexed to the left ventricular outflow tract area to obtain AVC density (AVCd). All analyses were adjusted for sex. RESULTS: Thirty-nine patients had a BAV and 161 a TAV. Median age was 51 and 72 years for BAV and TAV patients, respectively. There was a modest correlation between MG and AVCd (ρ=0.51, p<0.0001) in the whole cohort. After dichotomisation for valve anatomy, there was a good correlation between AVCd and MG in the TAV group (ρ=0.61, p<0.0001) but weak correlation in the BAV group (ρ=0.32, p=0.046). In the TAV group, the strength of the AVCd-MG correlation was similar in younger (<72 years old; ρ=0.59, p<0.0001) versus older (≥72 years old; ρ=0.61, p<0.0001) patients. In the BAV group, there was no correlation between AVCd and MG in younger patients (<51 years old; ρ=0.12, p=0.65), whereas there was a good correlation in older patients (≥51 years old; ρ=0.55, p=0.009). AVCd (p=0.005) and age (p=0.02) were both independent determinants of MG in BAV patients while AVCd (p<0.0001) was the only independent determinant of MG in TAV patients. CONCLUSIONS: In patients with TAV as well as in older patients with BAV, AVCd appears to be the main factor significantly associated with the haemodynamic severity of AS and so it may be used to corroborate AS severity in case of uncertain or discordant findings at echocardiography. However, among younger patients with BAV, some may have a haemodynamically significant stenosis with minimal AVCd. The results of MDCT AVCd should thus be interpreted cautiously in this subset of patients. TRIAL REGISTRATION NUMBER: NCT01679431; Pre-results.
Shen et al. (Mon,) conducted a cohort in Aortic stenosis (n=200). Aortic valve anatomy (Tricuspid vs Bicuspid) was evaluated on Correlation between aortic valve calcification density and mean transvalvular gradient (ρ=0.51, p=<0.0001). Aortic valve calcification density correlated well with mean transvalvular gradient in TAV patients (ρ=0.61) and older BAV patients (ρ=0.55), but not in younger BAV patients (ρ=0.12, p=0.65).
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