Impact of Aortic Valve Calcification, as Measured by MDCT, on Survival in Patients With Aortic Stenosis

Clavel, Marie‐Annick; Pîbarot, Philippe; Messika–Zeitoun, David; Capoulade, Romain; Malouf, Joseph F.; Aggarval, Shivani; Araoz, Phillip A.; Michelena, Héctor I.; Cueff, Caroline; Larose, Éric; Miller, Jordan D.; Vahanian, Alec; Enríquez-Sarano, Maurice

doi:10.1016/j.jacc.2014.05.066

Cited by 397 publications

(237 citation statements)

References 37 publications

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“…In support of this is the larger AVAi at baseline in the low-gradient group together with lower aortic calcium burden at computed tomography, a proven surrogate both for degree of stenosis and survival. 12 This would fit with available survival data indicating that NFLG is associated with significantly lower event rates than LFLG, [13][14][15] strongly suggesting that the NFLG entity is in fact a halfway house between moderate and severe AS.…”

Section: Is Nflg a Less-severe Form Of As?supporting

confidence: 56%

Assessment of Normal-Flow Aortic Stenosis

Bleakley

Monaghan

2017

Circ: Cardiovascular Imaging

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Section: Is Nflg a Less-severe Form Of As?supporting

confidence: 56%

Assessment of Normal-Flow Aortic Stenosis

Bleakley

Monaghan

2017

Circ: Cardiovascular Imaging

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“…The summation of per‐slice lesion scores was performed individually for every aortic valve calcification score. In order to take into account the interpatient variability in valve size, we used the aortic valve calcification density, where aortic valve calcification was divided by the cross‐sectional aortic annulus area (π×[Aortic annulus diameter/2] 2 ) measured by echocardiography 14, 26, 27…”

Section: Methodsmentioning

confidence: 99%

Impact of Vascular Hemodynamics on Aortic Stenosis Evaluation: New Insights Into the Pathophysiology of Normal Flow—Small Aortic Valve Area—Low Gradient Pattern

Côté

Simard

Zenses

et al. 2017

JAHA

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BackgroundAbout 50% of normal‐flow/low‐gradient patients (ie, low mean gradient [MG] or peak aortic jet velocity and small aortic valve area) have severe aortic valve calcification as measured by computed tomography. However, they are considered to have moderate aortic stenosis (AS) in current American College of Cardiology/American Heart Association guidelines. The objective was thus to evaluate the effect of hypertension and reduced arterial compliance (rAC) on MG and Vpeak measurements.Methods and ResultsDoppler‐echocardiography was performed in 4 sheep with experimentally induced severe and critical AS at: (1) normal aortic pressure, (2) during hypertension, and (3) with rAC. Hypertension and rAC induced a substantial decrease in MG/Vpeak compared with normal stage (both P≤0.03) despite a stable transvalvular flow (P>0.16). Hypertension and rAC resulted in a greater reduction of MG in critical (−42%) compared with severe (−35%) AS (P˂0.0001). Comprehensive Doppler‐echocardiography and computed tomography were performed in 220 AS patients (mean age: 69±13 years; MG 29±18 mm Hg) with normal flow. The population was divided in 3 groups according to the presence of hypertension and rAC. The slope of the linear association between MG/Vpeak and aortic valve calcification divided by the cross‐sectional area of the aortic annulus was significantly reduced in patients with hypertension and/or rAC compared with normotensive/normal AC patients (P<0.01). Accordingly, patients with normal‐flow/low‐gradient and severe aortic valve calcification density were more frequent in hypertension and rAC groups compared with the normotensive/normal‐AC group (16% and 12% compared with 2%; P=0.03).ConclusionsHypertension and rAC are associated with a substantial reduction in MG/Vpeak for similar aortic valve calcification (ie, similar AS anatomic severity), which may lead to underestimation of AS hemodynamic severity.

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“…High AVC and MVC were noted in 6% (n ¼ 209) and 4% (n ¼ 155), respectively. While severe aortic stenosis has been defined using CT scan, 29 the number of patients in the MESA cohort with AVC >1274 AU (292 AU/ cm 2 ) in women (n ¼ 3) and >2065 AU (476 AU/cm 2 ) in men (n ¼ 3) was insufficient for us to study. Age significantly increased from noncalcified aortic and mitral valves compared to those with high calcification.…”

Section: Participant Populationmentioning

confidence: 99%

Relationship of Aortic Wall Distensibility to Mitral and Aortic Valve Calcification: The Multi-Ethnic Study of Atherosclerosis

et al. 2017

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Data are limited on whether valvular calcification is associated with aortic wall stiffness. We tested whether aortic valve calcification (AVC) and/or mitral valve calcification (MVC) is inversely associated with aortic distensibility (AD). Cross-sectional study conducted in a subset of the Multi-Ethnic Study of Atherosclerosis (MESA) included 3676 MESA participants aged 44 to 84 years with AD measured with magnetic resonance imaging and with AVC and MVC measured with noncontrast cardiac computed tomography scans. Both AVC and MVC were divided into 3 categories: zero, < median values (low), and ! median values (high) for patients with nonzero values. Overall, 88% (n ¼ 3256) and 92% (n ¼ 3365) of participants had zero AVC and MVC, while 6% (n ¼ 211) and 4% (n ¼ 156) had low, and 6% (n ¼ 209) and 4% (n ¼ 155) had high values of AVC and MVC, respectively. The AVC was independently associated with AD after adjusting for age, gender, and ethnicity (P ¼ .035). No association was noted between AVC groups and AD after adjustment for all covariates or MVC groups and AD in any model.

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Impact of Aortic Valve Calcification, as Measured by MDCT, on Survival in Patients With Aortic Stenosis

Cited by 397 publications

References 37 publications

Assessment of Normal-Flow Aortic Stenosis

Assessment of Normal-Flow Aortic Stenosis

Impact of Vascular Hemodynamics on Aortic Stenosis Evaluation: New Insights Into the Pathophysiology of Normal Flow—Small Aortic Valve Area—Low Gradient Pattern

Relationship of Aortic Wall Distensibility to Mitral and Aortic Valve Calcification: The Multi-Ethnic Study of Atherosclerosis

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