Diagnostic role of aortic valve calcium scoring in various etiologies of aortic stenosis

Abstract

Most of the studies about aortic valve calcium (AVC) score in aortic stenosis (AS) were based on degenerative or bicuspid AS but not rheumatic AS. We aimed to study the diagnostic accuracy of AVC score to determine severe AS in various etiologies. Adult patients diagnosed with mild to severe AS were enrolled. AVC score were identified from multi-detector computed tomography (MDCT) scan. The AVC score was highest in bicuspid AS (3211.9 (IQR (1100.0–4562.4) AU) compared to degenerative AS (1803.7 (IQR (1073.6–2550.6) AU)), and rheumatic AS (875.6 (IQR 453.3–1594.0) AU), p < 0.001. For the ROC curve to identify severe AS, the AVC score performed well in degenerative and bicuspid AS with the area under the ROC curve (AuROC) 0.834 (95% CI, 0.730, 0.938) in degenerative group; and 0.820 (95% CI, 0.687, 0.953) in bicuspid AS. Whereas AVC score had non-significant diagnostic accuracy with AuROC 0.667 (95% CI, 0.357, 0.976) for male and 0.60(95% CI, 0.243, 0.957) for female in rheumatic AS. The cut-off AVC score values to identify severe AS were AVCS > 2028.9AU (male) and > 1082.5AU (female) for degenerative AS, and > 2431.8AU (male) and > 1293.5AU (female) for bicuspid AS. In conclusions, AVC score is the accurate test for assessing severity in patients with degenerative and bicuspid AS but performs poorly in rheumatic AS group.

Aortic Valve Calcium Score by Computed Tomography as an Adjunct to Echocardiographic Assessment—A Review of Clinical Utility and Applications

“…Interestingly, this is much lower than the previously identified cut-offs for TAV patients [77], despite paradoxically reporting a higher mean AVCS in BAV with severe AS at 3497.71 ± 2470.17 AU. Contrasting with this study, Wanchaitanawong et al identified an AVCS cut-off in BAV patients (n = 43) to be much higher than that noted by Ren et al, with cut-offs closer to those with severe AS with three cusps; AVCS ≥ 1145 AU (sensitivity 83.3%, specificity 80%) for females and ≥2431.8 AU (sensitivity 92.9%, specificity 71.4%) for males [78].…”

“…This was postulated to be a result of the pattern of calcium distribution, with a higher calcium load found on the aortic commissure compared to the valve leaflets (as is seen in TAV and BAV AS). These patients were also younger than typical TAV or BAV patients with AS, noting that age is a significant risk factor for the incidence of AV calcification [78].…”

“…Pathologically, this is thought to be due to higher shear stress on the valve leaflets resulting in earlier fibrosis and calcification [35]. BAV thus leads to preferential calcification of the aortic valve cusps, which progresses to AS and/or aortic regurgitation (Figure 4A,C) [78]. In addition, 20-40% of patients with BAV develop aortic root dilation, associated with an increased risk of aortic dissection (Figure 4B) [3].…”

“…Additionally, Wanchaitanawong et al in 2023 highlighted another limitation of AVCS by CT in their evaluation of its use in rheumatic AV disease [78]. Analysis of 27 patients with rheumatic AV disease found no significant correlation with AVCS and TTE hemodynamics for AS severity.…”