What is the clinical evidence from this study?

Study design: Observational. Population: Bicuspid aortic valve stenosis. Intervention: Computed tomography-derived aortic valve calcification (AVC) and AVC density (AVCd) vs. Echocardiography. Primary outcome: Accuracy (sensitivity and specificity) to identify severe aortic stenosis (Se/Spe = 86/80%).

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.

April 1, 2022Open Access

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

MSMylène ShenStructural Heart Disease JOJin Kyung OhChungnam National University EGEzéquiel GuzzettiCardiac Imaging

Key Result

CT-derived aortic valve calcification density thresholds currently proposed in guidelines have good accuracy (sensitivity 86%, specificity 80%) to confirm severe AS in bicuspid aortic valve patients.

Study Design

Type

Observational

Multicenter

Yes

Structured PICO

Does CT-derived aortic valve calcium scoring accurately identify severe aortic stenosis in patients with bicuspid aortic valves compared to echocardiography?

Population

Patients with bicuspid aortic valve (BAV) with at least mild aortic stenosis (AS) and preserved left ventricular ejection fraction, including Caucasian and Asian ethnicities

Intervention

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

Comparator

Hemodynamic severity of AS obtained by echocardiography

Outcome

Accuracy (sensitivity and specificity) of previously established thresholds to identify severe ASsurrogate

Currently proposed guideline thresholds for CT-derived aortic valve calcium scoring have good accuracy for confirming severe aortic stenosis in patients with bicuspid aortic valves.

Main Result

Effect estimate: Se/Spe = 86/80%

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.

Ask AI

Helpful

Bookmark

View Full Paper