Computed Tomography Aortic Valve Calcium Scoring in Patients With Bicuspid Aortic Valve Stenosis

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Bicuspid aortic valve stenosis (n=485). Intervention: Computed tomography-derived aortic valve calcification (AVC) and AVC density (AVCd) vs. Echocardiography (hemodynamic severity). Primary outcome: Accuracy (sensitivity and specificity) of previously established thresholds to identify severe aortic stenosis (Sensitivity 86%, Specificity 80% for AVCd).

Q: What does this research mean for the field?

CT-derived aortic valve calcification density thresholds currently proposed in guidelines have good accuracy (sensitivity 86%, specificity 80%) to confirm severe aortic stenosis in patients with bicuspid aortic valves. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

Mylène Shen; Jin Kyung Oh; Ezéquiel Guzzetti; Gurpreet K. Singh; Tania Pawade; Lionel Tastet; Marie‐Annick Clavel; Victoria Delgado; Jeroen J. Bax; Marc R. Dweck; Amr E. Abbas; Ramy Mando; Mariano Falconi; Diego Pérez de Arenaza; Kian Keong Poh; William Kong; Edgar Tay; Gregg S. Pressman; Daniel Brito; Jae Kwan Song; Philippe Pîbarot

doi:10.1016/j.shj.2022.100027

Key result

CT-derived aortic valve calcification density identifies severe bicuspid AS with ~86% sensitivity.

Sensitivity 86%, Specificity 80% for AVCd
n=485

Figures

Why the study?

Sex-specific CT-derived AVC and AVCd thresholds for severe AS were established mainly in Caucasians with tricuspid valves, leaving their accuracy unclear in BAV patients and by ethnicity.

Does CT-derived aortic valve calcium scoring accurately identify severe aortic stenosis in patients with bicuspid aortic valves across different ethnicities?

Study Design

Type

Observational (n=485)

Multicenter

Yes

Structured PICO

Does CT-derived aortic valve calcium scoring accurately identify severe aortic stenosis in patients with bicuspid aortic valves across different ethnicities?

P

Population

485 adults with bicuspid aortic valves and at least mild aortic stenosis with preserved ejection fraction evaluated in a multicenter international registry.

E

Exposure

Computed tomography (CT)-derived aortic valve calcification (AVC) and AVC density (AVCd) scoring

C

Comparator

Hemodynamic severity of aortic stenosis obtained by Doppler echocardiography (gold standard)

O

Outcome

Accuracy (sensitivity, specificity, and percentage of overall correct classification) of previously established sex-specific AVC and AVCd thresholds to identify severe aortic stenosissurrogate

Main Result

Effect estimate: Sensitivity 86%, Specificity 80% for AVCd

CT-derived aortic valve calcium scoring thresholds currently proposed in guidelines have good accuracy to confirm severe aortic stenosis in patients with bicuspid aortic valves, though optimal thresholds may be higher in Asian men.

Limitations

The vast majority of patients included in the study presented with severe aortic stenosis.
Several subgroup analyses were based on a small number of patients.
Only included patients of Caucasian or Asian ethnicity, limiting generalizability to Hispanic or African-American populations.
Not all centers used the same CT scanners to measure aortic valve calcification.
Threshold values were established in a subset of patients with concordant grading of AS severity, which may not perfectly apply to discordant cases.
Vast majority of patients presented with severe AS
Several subgroup analyses were based on a small number of patients
Only included patients of Caucasian or Asian ethnicity
Not all centers used the same CT scanners
Threshold values were established only in the subset of patients with concordant grading of AS severity

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Implication

May support CT calcium thresholds for bicuspid aortic stenosis; extends prior data but leaves optimal ethnic cutoffs open.

Abstract

Background: Sex-specific thresholds of computed tomography (CT)-derived aortic valve calcification (AVC) or AVC density (AVCd) to identify severe aortic stenosis (AS) have been established in populations that consisted mainly of Caucasians with a tricuspid aortic valve. The objective of this study was to evaluate the accuracy (i.e., sensitivity and specificity) of previously established thresholds to identify severe AS in patients with bicuspid aortic valve (BAV) and according to ethnicity: Caucasian vs. Asian. Methods: We built a multicenter registry of echocardiographic and CT data collected in BAV patients with at least mild AS and preserved left ventricular ejection fraction from 7 different centers. Anatomic severity of AS obtained by CT-derived AVC and AVCd was compared to hemodynamic severity of AS obtained by echocardiography. Results: (Se/Spe = 86/80%) for AVCd. Conclusions: The optimal thresholds to identify hemodynamically severe AS in BAV patients are similar in Caucasians but appear to be higher in Asian men, compared with thresholds previously reported in tricuspid aortic valve patients. Nonetheless, the thresholds currently proposed in the guidelines have good accuracy and can be applied in BAV patients to confirm AS severity.

Discussion

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Cite This Study

Shen et al. (2022) conducted an observational in Bicuspid aortic valve stenosis (n=485). Computed tomography-derived aortic valve calcification (AVC) and AVC density (AVCd) vs. Echocardiography (hemodynamic severity) was evaluated on Accuracy (sensitivity and specificity) of previously established thresholds to identify severe aortic stenosis (Sensitivity 86%, Specificity 80% for AVCd). Computed tomography-derived aortic valve calcification density thresholds showed good accuracy to identify severe aortic stenosis in patients with bicuspid aortic valves, though optimal thresholds were higher in Asian men.

synapsesocial.com/papers/6a1853f8b1bf25371265b584 https://doi.org/10.1016/j.shj.2022.100027

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Computed Tomography Aortic Valve Calcium Scoring in Patients With Bicuspid Aortic Valve Stenosis

Figures

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Computed Tomography Aortic Valve Calcium Scoring in Patients With Bicuspid Aortic Valve Stenosis

Figures

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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