Multislice Computed Tomography for Detection of Patients With Aortic Valve Stenosis and Quantification of Severity

Feuchtner, Gudrun; Dichtl, Wolfgang; Friedrich, Guy; Frick, M.; Alber, Hannes; Schachner, Thomas; Bonatti, Johannes; Mallouhi, Ammar; Frede, Thomas; Pachinger, Otmar; Nedden, Dieter zur; Müller, Silvana

doi:10.1016/j.jacc.2005.11.056

Cited by 154 publications

(57 citation statements)

References 20 publications

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“…35 Hence, CT has emerged as an adjunct to Doppler echocardiography in the determination of AS severity. 47 Indeed, although Doppler echocardiography quantifies the hemodynamic degree of AS, CT measures the intrinsic lesion of the valve and provides an additional parameter to evaluate calcified aortic valve disease severity. AVC measurement by MDCT is a fast, simple, noninvasive, highly feasible, widely available, and highly reproducible technique.…”

Section: Avc-as Diagnosismentioning

confidence: 99%

Sex Differences in Aortic Valve Calcification Measured by Multidetector Computed Tomography in Aortic Stenosis

Aggarwal

Clavel

Messika–Zeitoun

et al. 2013

Circ: Cardiovascular Imaging

218

130

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A ortic stenosis (AS) is common in elderly people, affecting 2% of the population ≥65 years old and 4.6% of population ≥75 years old based on Doppler echocardiographic or community studies.1,2 Nowadays, the most common cause of AS is degenerative, and aortic valve calcification (AVC) is the intrinsic mechanism of valvular stiffening and obstruction. [3][4][5][6] Although degenerative AS has long been considered age related, recent studies have demonstrated that it is an active process involving biological pathways with many similarities to atherosclerosis. 7,8 Epidemiological studies identified similar risk factors for calcific AS and coronary atherosclerosis such as age, smoking, elevated cholesterol levels, diabetes mellitus, metabolic syndrome, hypertension, and increase in lipoprotein-a levels. 9 Male sex was also touted as an independent risk factor for AS similar to atherosclerosis, 9 but studies linking valve tissue alterations 10,11 and calcification to AS 12 have not differentiated between men and women. Moreover, studies of aortic valve weight as a surrogate for calcification load showed discordant results with regard to sex, 13,14 and clinically, guidelines do not differentiate between men and women for AS pathophysiology and management. 6 However, the analogy to atherosclerosis suggests that there may be important, yet thus far undefined, sex-related differences in the development of AVC and the transition to AS. This issue can now be analyzed because cardiac computed tomography (CT) provides accurate and reproducible quantification of AVC load, 15 and multidetector CT (MDCT) may prove to be a useful adjunct tool for the evaluation of AS severity. However, previous studies suggested a single set of cutoff values for detecting severe AS regardless of sex, 16 so the impact of sex on the relation between aortic cusp calcification measured by MDCT and hemodynamic severity of AS remains uncertain. The aim of the present study was to determine the differential physiological relationship between AVC Background-Aortic valve calcification (AVC) is the intrinsic mechanism of valvular obstruction leading to aortic stenosis (AS) and is measurable by multidetector computed tomography. The link between sex and AS is controversial and that with AVC is unknown. Methods and Results-We Conclusions-In Aggarwal et al Aortic Valve Calcification in Women 41load and AS hemodynamic severity between men and women. We hypothesized that women reach thresholds for severe AS for lower calcification loads than men and that when MDCT is used for the diagnosis of AS severity, criteria of AVC load would need to be adjusted specifically for each sex. Methods Study PopulationWe prospectively enrolled patients with at least mild calcific AS in whom we performed noncontrast MDCT scan for the evaluation of AVC and comprehensive transthoracic echocardiography within 90 Creatinine Clearance age k gPatients from the Bichat Hospital were enrolled in 2 ongoing prospective studies on aortic valve calcification/stenosis (COFRASA; www.clinica...

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Section: Avc-as Diagnosismentioning

confidence: 99%

Sex Differences in Aortic Valve Calcification Measured by Multidetector Computed Tomography in Aortic Stenosis

Aggarwal

Clavel

Messika–Zeitoun

et al. 2013

Circ: Cardiovascular Imaging

218

130

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“…However, using only two phases resulted in only moderate correlation with the short-axis approach for EF, and it also showed a significant overestimation of myocardial mass and significantly larger limits of agreement for EF and ESV with respect to the region-growing approach using 10 phases, thus proving to be inferior to the manually adjusted region-growing approach. Furthermore, using all 10 phases of the cardiac cycle may also lead to further diagnostic information, such as regional assessment of LV function [13] or the evaluation of the aortic valve [25,26], especially as part of the emerging ''triple-rule-out'' protocols [27][28][29]. Any increase in the number of phases of the cardiac cycle used for analysis, on the other hand, may only lead to a minimal increase of diagnostic gain, as recently reported by Puesken et al [30], but requiring larger storage and network capacities.…”

Section: Automatic Vs Semi-automatic Global Cardiac Function Assessmentmentioning

confidence: 99%

Automaticvssemi-automatic global cardiac function assessment using 64-row CT

Greupner

Zimmermann²,

Hamm³

et al. 2012

BJR

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Objective: Global cardiac function assessment using multidetector CT (MDCT) is timeconsuming. Therefore we sought to compare an automatic software tool with an established semi-automatic method. Methods: A total of 36 patients underwent CT with 6460.5 mm detector collimation, and global left ventricular function was subsequently assessed by two independent blinded readers using both an automatic region-growing-based software tool (with and without manual adjustment) and an established semi-automatic software tool. We also analysed automatic motion mapping to identify end-systole. Results: The time needed for assessment using the semi-automatic approach (12:12¡6:19 min) was reduced by 75-85% with the automatic software tool (unadjusted, 01:34¡0:29 min, adjusted, 02:53¡1:19 min; both p,0.001). There was good correlation (r50.89; p,0.001) for the ejection fraction (EF) between the adjusted automatic (58.6¡14.9%) and the semi-automatic (58.0¡15.3%) approaches. Also the manually adjusted automatic approach led to significantly smaller limits of agreement than the unadjusted automatic approach for end-diastolic volume (¡36.4 ml vs ¡58.5 ml, p.0.05). Using motion mapping to automatically identify end-systole reduced analysis time by 95% compared with the semi-automatic approach, but showed inferior precision for EF and end-systolic volume. Conclusion: Automatic function assessment using MDCT with manual adjustment shows good agreement with an established semi-automatic approach, while reducing the analysis by 75% to less than 3 min. This suggests that automatic CT function assessment with manual correction may be used for fast, comfortable and reliable evaluation of global left ventricular function.

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“…Planimetry, however, is a less than optimal approach in patients with calcific AS because leaflet calcification and jet turbulence often make accurate visualisation of the true orifice difficult, and because of the complex three-dimensional (3D) shape of the stenotic orifice. Multislice cardiac CT may be useful in quantifying valve calcification and AVA [24,25]. At present, it would appear that CT overestimates AVA compared with TTE [26].…”

Section: Aortic Stenosismentioning

confidence: 99%

Cardiac imaging in valvular heart disease

Choo

Steeds²

2011

BJR

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Multislice Computed Tomography for Detection of Patients With Aortic Valve Stenosis and Quantification of Severity

Abstract: Multislice computed tomography may provide an accurate, noninvasive imaging technique for detection of patients with AS and quantification of AVA.

Cited by 154 publications

References 20 publications

Sex Differences in Aortic Valve Calcification Measured by Multidetector Computed Tomography in Aortic Stenosis

Sex Differences in Aortic Valve Calcification Measured by Multidetector Computed Tomography in Aortic Stenosis

Automaticvssemi-automatic global cardiac function assessment using 64-row CT

Cardiac imaging in valvular heart disease

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