Revisiting the Aortic Valve Calcium Score in Evaluating the Severity of Aortic Stenosis in Japanese Patients　― A Single-Center Study ―

Figures

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  Figure 1.. Patient distribution according to aortic stenosis (AS) grading. Of the 512 patients included in the study, 152 (29.7%) were categorized as having concordant grading (CG)-severe AS (aortic valve area index [AVAi] ≤0.6 cm2/m2, mean transvalvular pressure gradient [mPG] ≥40 mmHg), 105 (20.5%) as having CG-moderate AS (AVAi >0.6 cm2/m2, mPG <40 mmHg), 244 (47.7%) as having discordant grading (DG)-low mPG (AVAi ≤0.6 cm2/m2, mPG <40 mmHg), and 11 (2.1%) as having DG-high mPG (AVAi >0.6 cm2/m2, mPG ≥40 mmHg). The red and blue dots represent females and males, respectively.

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  Figure 2.. Distribution of (A) aortic valve calcification (AVC), (B) AVC density, and (C) AVC index (AVCi). The boxes show the interquartile range, with the median value indicated by the horizontal line; whiskers show the range within 1.5-times the interquartile range. Aortic stenosis (AS) grading classification is shown along the x-axis (i.e., concordant grading (CG) moderate AS, discordant grading (DG) low mean transvalvular gradient (mPG) AS, DG-high mPG AS, and CG-severe AS).

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  Figure 3.. Associations between aortic valve calcification (AVC) and Doppler echocardiographic indices: (A) peak aortic jet velocity (Vmax); (B) mean transvalvular pressure gradient (mPG); (C) aortic valve area (AVA); and (D) AVA indexed to body surface area (AVAi). Overall, a higher AVC was associated with higher severity of aortic stenosis (AS) in all measures. However, the same AVC indicates more severity in echocardiographic measures in women than in men, as the regression lines show.

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  Figure 4.. Receiver operating characteristics curve predicting severe aortic stenosis (AS). (Upper panels) Patients with overall concordant grading; (Middle panels) patients with low ejection fraction (<50%); and (Bottom panels) patients with low flow (stroke volume index [SVi] ≤35 mL/m2). Data are shown separately for women (Left) and men (Right). AUC, area under the curve; AVC, aortic valve calcification.

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  Figure 5.. Kaplan-Meier analysis for the composite endpoint in discordant grading (DG) groups. DG aortic stenosis (AS) patients (A) overall and those stratified into (B) paradoxical low-flow, low-gradient (LF-LG) AS (ejection fraction [EF] ≥50%, stroke volume index [SVi] ≤35 mL/min) and (C) classical LF-LG AS (EF <50%, SVi ≤35 mL/min). The endpoint of interest was defined as a composite of death, transcatheter aortic valve implantation, and aortic valve replacement. P values are from log-rank tests. AVC, aortic valve calcification; CT, computed tomography.