Aortic Valve Calcium Score by Computed Tomography as an Adjunct to Echocardiographic Assessment—A Review of Clinical Utility and Applications

Figures

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  Figure 1. Stylized progression of aortic stenosis in a three-cusp aortic valve with listed areas representing cross-section of aortic valve opening (top panel). The bottom left image demonstrates the most common two morphologies in AS, bicuspid valve and three cusp AV with calcific degeneration, and the bottom right panel depicts secondary left ventricular hypertrophy due to severe aortic stenosis (bottom panel).

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  Figure 2. A 69-year-old male with bicuspid aortic valve and shortness of breath on exertion only at high elevations. He had discordant echocardiographic parameters for severity of aortic stenosis, with a clinical echocardiogram report noting overall moderate–severe aortic valve stenosis: systolic mean Doppler gradient (MG) 37 mmHg (A), aortic valve area (AVA) by Doppler 1.06 cm2 (B), dimensionless index 0.23, and normal indexed stroke volume (58 mL/m2). He proceeded to have an aortic valve calcium score (AVCS) by cardiac computed tomography ((C), red arrow) which demonstrated a score of 4568 AU, reclassifying aortic valve stenosis as severe. This scan also demonstrated calcification in the left anterior descending coronary artery ((D), yellow arrow).

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  Figure 3. Flow-chart of classification of aortic stenosis (AS) grading based on echocardiographic measurements. Figure has been based off published work with permission from [24]. Copyright 2017 Elsevier. Abbreviations; Aortic stenosis (AS); aortic valve area (AVA); mean gradient across aortic valve (MG); peak velocity across aortic valve (PAV); left ventricular (LV); left ventricular ejection fraction (LVEF); dobutamine stress echocardiography (DSE); stroke volume index (SVi); computed tomography (CT).

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  Figure 4. A 62-year-old asymptomatic female sent for coronary artery calcium (CAC) score for risk stratification for statin therapy. The CAC score was 0, but significant aortic valve calcification was identified (A). AVCS was quantified as 660 AU. She was also incidentally noted to have mid ascending aorta dilation with diameter of 45 mm (B). Subsequent echocardiogram for further evaluation confirmed a bicuspid aortic valve with raphe between the left and non-coronary cusp, demonstrated by arrow (C), and overall moderate aortic stenosis with mean gradient (MG) of 22 mmHg and peak aortic velocity (PAV) of 3 m/s (D).