Computed Tomography Aortic Valve Calcium Scoring in Patients With Aortic Stenosis

Pawade, Tania; Clavel, Marie‐Annick; Tribouilloy, Christophe; Dreyfus, Julien; Mathieu, Tiffany; Tastet, Lionel; Renard, C.; Gun, Mesut; Jenkins, William Steven Arthur; Macron, Laurent; Sechrist, Jacob W.; Lacomis, Joan M.; Nguyen, Virginia; Calabria, Hug Cuéllar; Ntalas, Ioannis; Cartlidge, Timothy Robert Graham; Prendergast, Bernard; Rajani, Ronak; Evangelista, Arturo; Cavalcante, João L.; Newby, David E.; Pîbarot, Philippe; Zeitoun, David Messika; Dweck, Marc R

doi:10.1161/circimaging.117.007146

Cited by 295 publications

(209 citation statements)

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“…43 Sex-specific cutoffs (>2000 Agatston units in men and >1300 in women) 43 recently were shown to be more closely associated with outcomes than echocardiographic parameters of aortic stenosis severity in a large multicenter registry. 44 Furthermore, the additional information obtained from a computed tomography study (severity of calcification of the valves, aortic annulus, aorta, mitral annulus, and coronary vessels) is important for procedural planning and for the assessment of other potential complications that can arise from valve interventions.…”

Section: Clinical Assessmentmentioning

confidence: 99%

Chronic kidney disease and valvular heart disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Marwick

Amann

Bangalore

et al. 2019

Kidney International

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100

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Section: Clinical Assessmentmentioning

confidence: 99%

Chronic kidney disease and valvular heart disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Marwick

Amann

Bangalore

et al. 2019

Kidney International

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100

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“…Because some studies have suggested sex-based differences in AVC severity, we repeated the analysis using sexspecific thresholds to identify severe AVC (>1200 AU for women and >2000 AU for men). 13,14 Higher T LV-Ao was still significantly associated with severe AVC (OR, 1.13; P = .01) (eTable 2 in the Supplement). When we subdivided T LV-Ao by median, patients with T LV-Ao greater than 66 milliseconds were 2.3 times more likely to demonstrate severe AVC.…”

Section: Diagnostic Ability Of T Lv-ao For Significant Av Calcificationmentioning

confidence: 97%

Association of Time Between Left Ventricular and Aortic Systolic Pressure Peaks With Severity of Aortic Stenosis and Calcification of Aortic Valve

et al. 2019

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Diagnosis of low-gradient severe aortic stenosis (AS) is challenging. We hypothesized that the time between left ventricular (LV) and aortic systolic pressure peaks (T LV-Ao) is associated with aortic stenosis (AS) severity and may have additive value in diagnosing severe AS, especially in patients with low-gradient AS. OBJECTIVE To investigate the diagnostic utility of measuring catheter-based T LV-Ao in patients with severe AS. DESIGN, SETTING, AND PARTICIPANTS We studied 123 patients with severe AS at the Cleveland Clinic Foundation, a tertiary referral center, who underwent transcatheter aortic valve replacement (TAVR) via femoral access and had pre-TAVR cardiac computed tomography assessment and hemodynamic measurements recorded during a TAVR procedure. All patients received hemodynamic evaluation, echocardiographic assessment, and quantification of aortic valve calcification (AVC) by multidetector computed tomography. Hemodynamic data were collected via left heart catheterization done just before TAVR, and T LV-Ao was calculated offline. Data were analyzed between October 5, 2015, and July 20, 2016. MAIN OUTCOMES AND MEASURES The association between T LV-Ao and AVC or other conventional imaging parameters was analyzed. RESULTS Of the included patients, the mean (SD) age was 81 (9) years, and 65 (54%) were men (54%). Among 123 patients, 48 patients (39%) had low-gradient AS (<40 mm Hg) and mean (SD) T LV-Ao was 69 (39) milliseconds. In multivariable logistic regression analyses, higher T LV-Ao (odds ratio [OR], 1.02; 95% CI, 1.01-1.04; P = .002) and higher peak aortic valve (AV) velocity (OR, 1.01; 95% CI, 1.00-1.02; P = .008) were independently associated with severe AVC (AVC >1000 AU). Adding T LV-Ao to the peak AV velocity and AV area showed significant incremental value to be associated with AVC, with a net reclassification improvement of 0.61 (95% CI, 0.23-0.99; P = .002) and integrated discriminatory improvement of 0.09 (95% CI, 0.03-0.16; P = .003). In a subgroup of patients with low-grade AS, higher T LV-Ao was the only parameter associated with severe AVC (OR, 1.02; 95% CI, 1.001-1.04; P = .03). CONCLUSIONS AND RELEVANCE Prolonged T LV-Ao was associated with severe AVC. This catheter-based hemodynamic index may be an additional surrogate to differentiate low-gradient true severe AS. Larger, prospective studies investigating the role of T LV-Ao as a marker of clinical outcomes in patients undergoing TAVR are required.

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“…The identified region on chromosome 12 displays an intronic variant in the CRADD gene as a top marker. Variation mapping to CRADD has been previously related to coronary artery calcification 27 , a phenotype strongly linked to calcific aortic valve disease and aortic stenosis 28 . The PheWAS data for rs71190365 indicate a link to known cardiac comorbidities such as forced expiratory volume and body mass, which may represent a pleiotropic effect-decreased area of the aortic valve is a determinant of cardiac output which governs cardiac output and exercise capacity 29 .…”

Section: Discussionmentioning

confidence: 99%

Cardiac imaging of aortic valve area from 26,142 UK Biobank participants reveal novel genetic associations and shared genetic comorbidity with multiple disease phenotypes

Córdova‐Palomera

Tcheandjieu

Fries

et al. 2020

Preprint

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The aortic valve is an important determinant of cardiovascular physiology and anatomic location of common human diseases. From a sample of 26,142 European-ancestry participants, we estimated functional aortic valve area by planimetry from prospectively obtained cardiac MRI sequences of the aortic valve. A genome-wide association study of aortic valve area in these UK Biobank participants showed two significant associations indexed by rs71190365 (chr13:50764607, DLEU1, p=1.8e-9) and rs35991305 (chr12:94191968, CRADD, p=3.4e-8). From the GWAS findings we constructed a polygenic risk score for aortic valve area, which in a separate cohort of 311,728 individuals without imaging demonstrated that smaller aortic valve area is predictive of increased risk for aortic valve disease (Odds Ratio 0.88, p=2.3e-6). After excluding subjects with a medical diagnosis of aortic valve stenosis (remaining n=310,546 individuals), phenome-wide association of >10,000 traits showed multiple links between the polygenic score for aortic valve disease and key health-related comorbidities involving the cardiovascular system and autoimmune disease. Genetic correlation analysis supports a shared genetic etiology with between aortic valve size and birthweight along with other cardiovascular conditions. These results illustrate the use of automated phenotyping of cardiac imaging data from the general population to investigate the genetic etiology of aortic valve disease, perform clinical prediction, and uncover new clinical and genetic correlates of cardiac anatomy.

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Computed Tomography Aortic Valve Calcium Scoring in Patients With Aortic Stenosis

Abstract: URL: http://www.clinicaltrials.gov. Unique identifiers: NCT01358513, NCT02132026, NCT00338676, NCT00647088, NCT01679431.

Cited by 295 publications

References 19 publications

Chronic kidney disease and valvular heart disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Chronic kidney disease and valvular heart disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Association of Time Between Left Ventricular and Aortic Systolic Pressure Peaks With Severity of Aortic Stenosis and Calcification of Aortic Valve

Cardiac imaging of aortic valve area from 26,142 UK Biobank participants reveal novel genetic associations and shared genetic comorbidity with multiple disease phenotypes

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