Significance of Aortic Valve Calcification in Patients With Low‐Gradient Low‐Flow Aortic Stenosis

Abstract

Background Assessment of patients with aortic stenosis (AS) and impaired left ventricular function remains challenging. Aortic valve calcium (AVC) scoring with computed tomography (CT) and fluoroscopy has been proposed as means of diagnosing and predicting outcomes in patients with severe AS. Hypothesis Severity of aortic valve calcification correlates with the diagnosis of true severe AS and outcomes in patients with low‐gradient low‐flow AS. Methods Echocardiography and CT database records from January 1, 2000 to September 26, 2009 were reviewed. Patients with aortic valve area (AVA) < 1.0 cm2 who had ejection fraction (EF) ≤ 25% and mean valvular gradient ≤ 25 mmHg with concurrent noncontrast CT scans were included. AVC was evaluated using CT and fluoroscopy. Mortality and aortic valve replacement (AVR) were established using the Social Security Death Index and medical records. The role of surgery in outcomes was evaluated. Results Fifty‐one patients who met the above criteria were included. Mean age was 75.1 ± 9.6 years, and 15 patients were female. Mean EF was 21% ± 4.6% with AVA of 0.7 ± 0.1 cm2. The peak and mean gradients were 35.5 ± 10.6 and 19.0 ± 5.1 mmHg, respectively. Median aortic valve calcium score was 2027 Agatston units. Mean follow‐up was 908 days. Patients with calcium scores above the median value were found to have increased mortality (P = 0.02). The benefit of surgery on survival was more pronounced in patients with higher valvular scores (P = 0.001). Fluoroscopy scoring led to similar findings, where increased AVC predicted worse outcomes (P = 0.04). Conclusions In patients with low‐gradient low‐flow AS, higher valvular calcium score predicts worse long‐term mortality. AVR is associated with improved survival in patients with higher valve scores.

Does mild paravalvular regurgitation post transcatheter aortic valve implantation affect survival? A meta‐analysis

“…Hence, mild PVR patients could have had worse prognosis as a manifestation of underlying high calcium burden, rather than as a result of direct negative effect of mild PVR. Higher aortic valve calcification was associated with worse long-term mortality in aortic stenosis patients [45,46]. In addition, calcification of coronary artery was associated with aortic and/or mitral valve calcification [47].…”

Vascular Calcification and Stone Disease: A New Look towards the Mechanism

“…, macrocalcification) [ 126 ] involving valvular endothelial cells, valve interstitial cells, inflammatory cells, and the extracellular matrix [ 131 ]. Some studies have associated valvular calcification with a faster progression of aortic stenosis which clinically manifests into exertional angina, syncope, and heart failure [ 131 ], and worse morbidity and mortality [ 132 ]. Additionally, vascular calcification is common in end-stage renal disease (ESRD) patients [ 133 ], due to their elevated risk of mineral metabolism disturbances [ 134 ].…”

Calcific Aortic Valve Disease: Part 1—Molecular Pathogenetic Aspects, Hemodynamics, and Adaptive Feedbacks

“…It is commonly expressed in old-age as degenerative tri-leaflet valve calcification, inasmuch as rheumatic disease is nowadays rare, and it is also referred to as age-related degenerative or dystrophic calcific AVS, and as calcific aortic valve disease (CAVD). Some 2% of the population have congenitally bicuspid aortic valves (BAV, see subsequent discussions), which are much more likely to calcify than tricuspid ones, and about 50% of these will develop CAVD [1–3]. The AV leaflets are made up of specialized valvular endothelial and interstitial cells akin to fibroblasts and an extracellular matrix (ECM) that contains collagen, elastin and glycosaminoglycans.…”