Contrast-enhanced CT indexed fibrocalcific volume increased with the severity of aortic stenosis, with a severe stenosis volume of 279 mm3/cm2 compared to mild stenosis volume of 109 mm3/cm2.
Does contrast-enhanced CT assessment of fibrocalcific volume correlate better with aortic stenosis severity than non-contrast CT calcium scoring in patients with aortic stenosis?
Contrast-enhanced CT assessment of aortic valve fibrocalcific volume correlates better with aortic stenosis severity than non-contrast CT calcium scoring, particularly in females where fibrosis is a significant contributor.
Effect estimate: null (95% CI null)
p-value: p=<0.001
Objectives Non-contrast CT aortic valve calcium scoring ignores the contribution of valvular fibrosis in aortic stenosis. We assessed aortic valve calcific and non-calcific disease using contrast-enhanced CT. Methods This was a post hoc analysis of 164 patients (median age 71 (IQR 66–77) years, 78% male) with aortic stenosis (41 mild, 89 moderate, 34 severe; 7% bicuspid) who underwent echocardiography and contrast-enhanced CT as part of imaging studies. Calcific and non-calcific (fibrosis) valve tissue volumes were quantified and indexed to annulus area, using Hounsfield unit thresholds calibrated against blood pool radiodensity. The fibrocalcific ratio assessed the relative contributions of valve fibrosis and calcification. The fibrocalcific volume (sum of indexed non-calcific and calcific volumes) was compared with aortic valve peak velocity and, in a subgroup, histology and valve weight. Results Contrast-enhanced CT calcium volumes correlated with CT calcium score (r=0.80, p<0.001) and peak aortic jet velocity (r=0.55, p<0.001). The fibrocalcific ratio decreased with increasing aortic stenosis severity (mild: 1.29 (0.98–2.38), moderate: 0.87 (1.48–1.72), severe: 0.47 (0.33–0.78), p<0.001) while the fibrocalcific volume increased (mild: 109 (75–150), moderate: 191 (117–253), severe: 274 (213–344) mm 3 /cm 2 ). Fibrocalcific volume correlated with ex vivo valve weight (r=0.72, p<0.001). Compared with the Agatston score, fibrocalcific volume demonstrated a better correlation with peak aortic jet velocity (r=0.59 and r=0.67, respectively), particularly in females (r=0.38 and r=0.72, respectively). Conclusions Contrast-enhanced CT assessment of aortic valve calcific and non-calcific volumes correlates with aortic stenosis severity and may be preferable to non-contrast CT when fibrosis is a significant contributor to valve obstruction.
Cartlidge et al. (Fri,) conducted a other in Aortic stenosis (n=164). Contrast-enhanced CT vs. non-contrast CT was evaluated on Correlations between aortic stenosis severity and fibrocalcific volume. (null, 95% CI null, p=<0.001). Contrast-enhanced CT indexed fibrocalcific volume increased with the severity of aortic stenosis, with a severe stenosis volume of 279 mm3/cm2 compared to mild stenosis volume of 109 mm3/cm2.