Key result
Aortic valve calcification score strongly correlated with total valve calcium (R2 = 0.98, P < 0.001) and moderately with valve calcium concentration (R2 = 0.62, P < 0.001).
Why the study?
The study investigated the correlation and sex differences between total valve calcium, valve calcium concentration, and aortic valve calcification in explanted valves from patients with severe aortic valve stenosis undergoing AVR.
Does CT-assessed aortic valve calcification correlate with valvular calcium concentrations, and are there sex differences in patients with severe aortic stenosis?
Observational (n=69)
Does CT-assessed aortic valve calcification correlate with valvular calcium concentrations, and are there sex differences in patients with severe aortic stenosis?
Effect estimate: R2 = 0.98
p-value: p=<0.001
CT-derived aortic valve calcification scores strongly estimate total valve calcium but only moderately estimate calcium concentration, which is lower in females regardless of stenosis severity.
AVC score may proxy total valve calcium; hypothesis-generating for aortic stenosis assessment, needs prospective validation.
AIMS: The aims of this study were to investigate the correlation and sex differences between total valve calcium, valve calcium concentration, and aortic valve calcification (AVC) in explanted valves from patients with severe aortic valve stenosis undergoing aortic valve replacement (AVR). METHODS AND RESULTS: Sixty-nine patients with severe aortic stenosis (AS) scheduled for elective AVR underwent echocardiography and cardiac computed tomography (CT) prior to surgery (AVCin vivo) and CT of the explanted aortic valve (AVCex vivo). Explanted valves were prepared in acid solution, sonicated, and analysed with Arsenazo III dye to estimate total valve calcium and valve calcium concentration. Median AVCex vivo was 2082 (1421-2973) AU; mean valve calcium concentration was 1.43 ± 0.42 µmol Ca2+/mg tissue; median total valve calcium 156 (111-255) mg Ca2+, and valve calcium density 52 (35-81) mg/cm2. AVC displayed a strong correlation with total valve calcium (R2 = 0.98, P < 0.001) and a moderate correlation with valve calcium concentration (R2 = 0.62, P < 0.001). Valvular calcium concentration was associated with sex, aortic valve area, and mean gradient. After adjusting for age and estimated glomerular filtration rate, sex and mean gradient remained associated with valve calcium concentrations. CONCLUSION: AVC score provides a strong estimate for total valve calcium but to a lesser degree calcium concentration in the valve tissue of patients with severe AS. Females presented lower valvular calcium concentrations than males irrespective of AS severity, adding evidence and providing support to the important point that sex differences in valvular calcium concentration in AS does not reflect valvular size.
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Linde et al. (2020) conducted an observational in Severe aortic valve stenosis (n=69). Aortic valve calcification (AVC) score was evaluated on Correlation between AVC and total valve calcium (R2 = 0.98, p=<0.001). Aortic valve calcification score strongly correlated with total valve calcium (R2 = 0.98, P < 0.001) and moderately with valve calcium concentration (R2 = 0.62, P < 0.001).
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