Correlation between aortic valve calcium score and peak to peak gradient in patients with preserved or reduced ejection fraction

Introduction During the last decade, the use of aortic valve calcium (AVC) score as measured by multidetector computed tomography (MDCT) has gained ground as a reliable, supplemental method of detecting patients with severe aortic stenosis (AS). The correlation between AVC score and peak to peak gradient during left heart catheterization is not well studied. Purpose We aimed to study the relationship between AVC score and peak to peak gradient in patients with AS undergoing transcatheter aortic valve implantation (TAVI), classified in reduced and preserved ejection fraction (EF). Methods We retrospectively reviewed the medical records of 59 patients with tricuspid, degenerative, native valve severe AS that had TAVI in our hospital. All patients included had MDCT and Doppler echocardiography prior the operation while peak to peak gradient was measured during TAVI. Results Patients were classified according to their EF into Group A (N=46, preserved EF ≥50%) and Group B (N=13, reduced EF <50%). Mean AVC score was higher in the preserved EF group (mean AVC group A=3670HU, mean AVC group B=2910HU) but there was not statistical significant differences between the groups (p=0.19). In group A, AVC score positively correlated with measured peak to peak gradient (r=+0.59, p<0.001), Doppler-derived AV maximum velocity (r=+0.39, p=0.02) and mean AV gradient(r=+0.53, p=0.002), while in group B we did not found any significant association between AVC score and peak to peak gradient (p=0.92), AV maximum velocity (p=0.62) and mean AV gradient (p=0.07). Conclusion There was a strong correlation between AVC score and peak to peak gradient in patients with normal EF, but not in patients with low EF.