Quantifying Aortic Valve Calcification using Coronary Computed Tomography Angiography

Alqahtani, Abdulrahman M; Boczar, Kevin E.; Kansal, Vinay; Chan, Kwan L.; Dwivedi, Girish; Chow, Benjamin J.W.

doi:10.1016/j.jcct.2017.01.007

Cited by 26 publications

(32 citation statements)

References 20 publications

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“…We assessed the calcium amount of the aortic valve and the upper LVOT within 1 cm under annulus, recalculating Agatston Units (AU) adapted from the calcium volume on given Hounsfield Units (HU) for overall, and separated leaflet calcium burden using the "Mercedes Benz" tool for localization. A pre-specific threshold of at least 600 HU was set to account for the hyperdensity of the applied contrast medium as practicable approach according to current research data (15). All MSCT-reconstructions and depending analyses were done by experienced level 3 readers, for the most part prospectively, partly retrospective in case of missing data.…”

Section: Procedural Details and 3d Image Analysis Of Msctmentioning

confidence: 99%

New insights on potential permanent pacemaker predictors in TAVR using the largest self-expandable device

Veulemans¹,

Frank²,

Seoudy³

et al. 2020

Cardiovasc Diagn Ther

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Background: Post-procedural conduction disorders following transcatheter aortic valve replacement (TAVR) still remain frequent, especially using the largest self-expandable device (Medtronic Corevalve Evolut R TM , 34 mm, STHV-34). We, therefore, assessed previously described, predictive factors of permanent pacemaker (PPM) implantation in the context of the STHV-34, including calcification distribution, implantation depth and membranous septum length (MSL). Methods: We performed a dual centre analysis of 130 of 182 consecutive patients treated with STHV-34, further stratified into subjects without post-procedural PPM (-PPM n=100, 76.9%) and those requiring postprocedural PPM (+PPM n=30, 23.1%). These events were further analyzed by univariate and multivariate analysis according to several underlying conditions. Results: Multivariate analysis only depicted previous right bundle branch block [RBBB; OR: 11.52 (2.63-50.44), P=0.001] and eccentricity index of the left ventricular outflow tract (LVOT-EI) >0.3 [OR: 3.07 (1.22-7.77), P=0.018] as highly predictive for PPM-need, being also confirmed by c-statistics [area under the curve (AUC) =0.68; 95% confidence interval (CI): 0.57-0.80; P=0.0025]. There was only moderate correlation of implantation depth over the MSL in terms of PPM prediction (r=0.23; P<0.0001).Conclusions: This study offers new insights into potential PPM predictors using the STHV-34: previous RBBB and a pronounced LVOT-EI were independent predictors of PPM, while most of the previously reported determinants failed to predict PPM-need including MSL and implantation depth.

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Section: Procedural Details and 3d Image Analysis Of Msctmentioning

confidence: 99%

New insights on potential permanent pacemaker predictors in TAVR using the largest self-expandable device

Veulemans¹,

Frank²,

Seoudy³

et al. 2020

Cardiovasc Diagn Ther

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“…For now, there is no prognostic model and no consensus on a specific imaging biomarker that would allow for unambiguous, objective identification of patients with a high risk of PVL. The authors of only a few previous studies have attempted to establish an objective, quantitative methodology of AVC description (24,25). Single reports have indicated the role of AVC distribution in local PVL formation (26,27).…”

Section: Discussionmentioning

confidence: 99%

Paravalvular leak prediction after transcatheter aortic valve replacement with self-expandable prosthesis based on quantitative aortic calcification analysis

Wiktorowicz¹,

Wit²,

Malinowski³

et al. 2021

Quant Imaging Med Surg

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Background: Paravalvular leak (PVL) is one of the most common complications of transcatheter aortic valve replacement (TAVR) and affects short-and long-term outcomes. The aim of this study was to identify the computed tomography (CT) imaging biomarkers that allow PVL after TAVR to be predicted.Methods: Patients were included who had severe aortic valve stenosis, had undergone TAVR with a selfexpanding valve, and had undergone a pre-procedural CT scan. Data on baseline characteristics, procedural and long-term outcomes were collected retrospectively. We used MATLAB software with a self-developed algorithm for CT scan analysis and found parameters that quantified aortic valve calcifications (AVC) in detail.Results: Fifty patients were included. The identified CT-derived parameters included AVC size, volume, thickness and density, as well as calcium radial distribution. The volume of the largest calcium block, calcium perimeter and calcium size (assessed by Feret's diameter) showed a strong association with PVL occurrence after TAVR (P=0.012, P=0.001 and P=0.045, respectively). The prognostic model showed that a 10 mm 2 increase in the local AVC amount in each valve section was associated with a 9.8% (95% CI: 2-18%; P=0.019) increase in the risk of PVL occurrence in the corresponding area after TAVR. ROC analysis revealed that the cut-off point of the AVC area was 96.5 mm 2 in the polar coordinate system presentation. Kaplan-Meier curves showed worse PVL-free survival in patients with more than 96.5 mm 2 of calcium area (P=0.013; log-rank).Conclusions: Quantitative AVC assessment for PVL prediction may play an important role in screening before TAVR. In future, the use of quantitative AVC assessment as an imaging biomarker in TAVR candidates and the creation and extension of an online database containing quantitative AVC parameters may help to identify high PVL risk patients.

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“…Alqahtani et al, in their studies, assessed the possibility to estimate AVCS based on the MSCT examination of coronary arteries, assuming the calcification detection threshold based on ROI density measurement parameters placed at the ascending aorta, i.e., based on the mean and standard deviation of the abovementioned density. The calcification detection threshold was calculated based on a mathematical formula: mean + 2x standard deviation [ 17 ]. Similar to our study, it has been concluded that AVCS estimation, based on the angiographic phase of MSCT examination is possible and its results are reliable.…”

Section: Discussionmentioning

confidence: 99%

Estimation of Aortic Valve Calcium Score Based on Angiographic Phase Versus Reduction of Ionizing Radiation Dose in Computed Tomography

Gać

Kȩdzierski²,

Macek

et al. 2021

Life

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The aim of the study was to evaluate the estimation efficacy of aortic valve calcium score (AVCS) based on the multislice computed tomography (MSCT) angiographic phase. The evaluation of the reduced amount of ionizing radiation dose was performed because of this estimation. The study included 51 consecutive patients who qualified for transcatheter aortic valve implantation (TAVI) (78.59 ± 5.72 years). All subjects underwent MSCT: in the native phase dedicated to AVCS as well as angiographic phases aimed to morphologically assess the aortic ostium and arterial accesses for TAVI. Based on the native phase, an AVCS assessment was performed for axial reconstructions at 3.0 mm and 2.0 mm slice thickness (AVCSnative3.0 and AVCSnative2.0). Based on the angiographic phase AVCS was estimated for axial reconstruction at 0.6 mm slice thickness with increased values of lesion density in aortic valve cusps/aortic valve annulus, which is considered a calcification, from a typical value of 130 HU to 500 HU and 600 HU (AVCSCTA0.6 500 HU and AVCSCTA0.6 600 HU). Mathematical formulations were developed, allowing for AVCS native calculation based on AVCS values estimated based on the angiographic phase: AVCSnative3.0 = 813.920 + 1.510 AVCSCTA0.6 500 HU; AVCSnative3.0 = 1235.863 + 1.817 AVCSCTA0.6 600 HU; AVCSnative2.0 = 797.471 + 1.393 AVCSCTA0.6 500 HU; AVCSnative2.0 = 1228.310 + 1.650 AVCSCTA0.6 600 HU. The amount of a potential reduction in dose length product (DLP) in the case of AVCS estimation was 4.45 ± 1.54%. In summary, relying solely on the angiographic phase of MSCT examination before TAVI, it is possible to conclusively estimate AVCS. This estimation results in a marked reduction in radiation dose in MSCT.

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Quantifying Aortic Valve Calcification using Coronary Computed Tomography Angiography

Cited by 26 publications

References 20 publications

New insights on potential permanent pacemaker predictors in TAVR using the largest self-expandable device

New insights on potential permanent pacemaker predictors in TAVR using the largest self-expandable device

Paravalvular leak prediction after transcatheter aortic valve replacement with self-expandable prosthesis based on quantitative aortic calcification analysis

Estimation of Aortic Valve Calcium Score Based on Angiographic Phase Versus Reduction of Ionizing Radiation Dose in Computed Tomography

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