Usefulness of Aortic Valve Calcification in Patients With Low-Flow Aortic Stenosis.

IF 6.5 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Circulation: Cardiovascular Imaging Pub Date : 2025-01-01 Epub Date: 2025-01-08 DOI:10.1161/CIRCIMAGING.124.017122

Nils Sofus Borg Mogensen, Jordi Sanchez Dahl, Mulham Ali, Mohamed-Salah Annabi, Amal Haujir, Andréanne Powers, Rasmus Carter-Storch, Jasmine Grenier-Delaney, Jacob Eifer Møller, Kristian Altern Øvrehus, Philippe Pibarot, Marie-Annick Clavel

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Abstract

Background: Aortic valve calcification (AVC) has been shown to be a powerful assessment of aortic stenosis (AS) severity and a predictor of adverse outcomes. However, its accuracy in patients with low-flow AS has not yet been proven. The objective of the study was to assess the predictive value of AVC in patients with classical low-flow (CLF, that is, low-flow reduced left ventricular ejection fraction) or paradoxical low-flow (PLF, that is, low-flow preserved left ventricular ejection fraction) AS.

Methods: We prospectively included 641 patients, 319 (49.8%) with CLF-AS and 322 (50.2%) with PLF-AS, who underwent Doppler echocardiography and multidetector computed tomography. AVC ratio (AVCratio) was calculated as AVC divided by the sex-specific AVC threshold for AS severity; AVC score ≥2000 Agatston units in male patients and ≥1200 Agatston units in female patients. The primary end point of the study was all-cause mortality regardless of treatment.

Results: Sex-specific AVC thresholds identified AS severity correctly in 137 (87%) of the patients. During a median follow-up of 4.9 (4.3-5.9) years, there were 265 deaths. After comprehensive adjustment, AVCratio was associated with all-cause mortality in patients with CLF-AS (adjusted hazard ratio, 1.25 [95% CI, 1.01-1.56]; P=0.046) and PLF-AS (adjusted hazard ratio, 1.51 [95% CI, 1.14-2.00]; P=0.004). There was an interaction (P=0.001) between AVC and AS flow patterns (ie, CLF versus PLF) with regard to the prediction of mortality. The best AVCratio threshold to predict mortality was different in patients with CLF-AS (AVCratio ≥0.7) and PLF-AS (AVCratio ≥1). After a comprehensive analysis, AVCratio as a dichotomic variable was associated with all-cause mortality in all groups (P≤0.001). The addition of AVCratio to the models improved all models' predictive value (all net reclassification index >18%; all P≤0.05).

Conclusions: In patients with CLF-AS or PLF-AS, AVC is a major predictor of mortality. Thus, AVC should be used in low-flow patients to assess AS severity and stratify risk. Importantly, in patients with reduced left ventricular ejection fraction, a nonsevere AS (ie, AVC 70% of severe) could be associated with reduced survival.

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主动脉瓣钙化在低流量主动脉狭窄患者中的应用。

背景：主动脉瓣钙化（AVC）已被证明是主动脉瓣狭窄（AS）严重程度的有力评估指标和不良结局的预测指标。然而，其在低流量AS患者中的准确性尚未得到证实。本研究的目的是评估AVC在经典低流量（CLF，即低流量降低的左心室射血分数）或悖论低流量（PLF，即低流量保留的左心室射血分数）AS患者中的预测价值。方法：我们前瞻性地纳入641例患者，其中319例（49.8%）CLF-AS和322例（50.2%）PLF-AS，他们接受了多普勒超声心动图和多探测器计算机断层扫描。AVC比率（AVCratio）计算为AVC除以as严重程度的性别特异性AVC阈值；AVC评分男性≥2000 Agatston单位，女性≥1200 Agatston单位。该研究的主要终点是不考虑治疗的全因死亡率。结果：性别特异性AVC阈值在137例（87%）患者中正确识别AS严重程度。在平均4.9（4.3-5.9）年的随访期间，有265人死亡。综合校正后，AVCratio与CLF-AS患者的全因死亡率相关(校正风险比为1.25 [95% CI, 1.01-1.56]；P=0.046)和PLF-AS(校正风险比，1.51 [95% CI, 1.14-2.00]；P = 0.004)。AVC和AS血流模式（即CLF vs PLF）在预测死亡率方面存在相互作用（P=0.001）。预测死亡率的最佳AVCratio阈值在CLF-AS （AVCratio≥0.7）和PLF-AS （AVCratio≥1）患者中存在差异。综合分析，AVCratio作为二分类变量与所有组的全因死亡率相关（P≤0.001）。AVCratio的加入使所有模型的预测值(所有净重分类指数>提高了18%；所有P≤0.05)。结论：在CLF-AS或PLF-AS患者中，AVC是死亡率的主要预测因子。因此，AVC应用于低血流患者，以评估AS的严重程度和分层风险。重要的是，在左心室射血分数降低的患者中，非严重AS（即AVC为严重的70%）可能与生存期降低相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Circulation: Cardiovascular Imaging 医学-核医学

CiteScore

6.30

自引率

2.70%

发文量

225

审稿时长

6-12 weeks

期刊介绍： Circulation: Cardiovascular Imaging, an American Heart Association journal, publishes high-quality, patient-centric articles focusing on observational studies, clinical trials, and advances in applied (translational) research. The journal features innovative, multimodality approaches to the diagnosis and risk stratification of cardiovascular disease. Modalities covered include echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging and spectroscopy, magnetic resonance angiography, cardiac positron emission tomography, noninvasive assessment of vascular and endothelial function, radionuclide imaging, molecular imaging, and others. Article types considered by Circulation: Cardiovascular Imaging include Original Research, Research Letters, Advances in Cardiovascular Imaging, Clinical Implications of Molecular Imaging Research, How to Use Imaging, Translating Novel Imaging Technologies into Clinical Applications, and Cardiovascular Images.