Andréanne Powers, Mulham Ali, Nicolas Lavoie, Amal Haujir, Nils Sofus Borg Mogensen, Sebastian Ludwig, Kristian Altern Øvrehus, Lionel Tastet, Catherine Rhéaume, Niklas Schofer, Jordi Sanchez Dahl, Marie-Annick Clavel
{"title":"通过 MDCT 测量主动脉瓣钙化密度以评估主动脉瓣狭窄严重程度","authors":"Andréanne Powers, Mulham Ali, Nicolas Lavoie, Amal Haujir, Nils Sofus Borg Mogensen, Sebastian Ludwig, Kristian Altern Øvrehus, Lionel Tastet, Catherine Rhéaume, Niklas Schofer, Jordi Sanchez Dahl, Marie-Annick Clavel","doi":"10.1161/CIRCIMAGING.123.016267","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Aortic valve calcification (AVC) indexation to the aortic annulus (AA) area measured by Doppler echocardiography (AVCd<sub>Echo</sub>) provides powerful prognostic information in patients with aortic stenosis (AS). However, the indexation by AA measured by multidetector computed tomography (AVCd<sub>CT</sub>) has never been evaluated. The aim of this study was to compare AVC, AVCd<sub>CT</sub>, and AVCd<sub>Echo</sub> with regard to hemodynamic correlations and clinical outcomes in patients with AS.</p><p><strong>Methods: </strong>Data from 889 patients, mainly White, with calcific AS who underwent Doppler echocardiography and multidetector computed tomography within the same episode of care were retrospectively analyzed. AA was measured both by Doppler echocardiography and multidetector computed tomography. AVCd<sub>CT</sub> severity thresholds were established using receiver operating characteristic curve analyses in men and women separately. The primary end point was the occurrence of all-cause mortality.</p><p><strong>Results: </strong>Correlations between gradient/velocity and AVCd were stronger (both <i>P</i>≤0.005) using AVCd<sub>CT</sub> (r=0.68, <i>P</i><0.001 and r=0.66, <i>P</i><0.001) than AVC (r=0.61, <i>P</i><0.001 and r=0.60, <i>P</i><0.001) or AVCd<sub>Echo</sub> (r=0.61, <i>P</i><0.001 and r=0.59, <i>P</i><0.001). AVCd<sub>CT</sub> thresholds for the identification of severe AS were 334 Agatston units (AU)/cm<sup>2</sup> for women and 467 AU/cm<sup>2</sup> for men. On a median follow-up of 6.62 (6.19-9.69) years, AVCd<sub>CT</sub> ratio was superior to AVC ratio and AVCd<sub>Echo</sub> ratio to predict all-cause mortality in multivariate analyses (hazard ratio [HR], 1.59 [95% CI, 1.26-2.00]; <i>P</i><0.001 versus HR, 1.53 [95% CI, 1.11-1.65]; <i>P</i>=0.003 versus HR, 1.27 [95% CI, 1.11-1.46]; <i>P</i><0.001; all likelihood test <i>P</i>≤0.004). AVCd<sub>CT</sub> ratio was superior to AVC ratio and AVCd<sub>Echo</sub> ratio to predict survival under medical treatment in multivariate analyses (HR, 1.80 [95% CI, 1.27-1.58]; <i>P</i><0.001 compared with HR, 1.55 [95% CI, 1.13-2.10]; <i>P</i>=0.007; HR, 1.28 [95% CI, 1.03-1.57]; <i>P</i>=0.01; all likelihood test <i>P</i><0.03). AVCd<sub>CT</sub> ratio predicts mortality in all subgroups of patients with AS.</p><p><strong>Conclusions: </strong>AVCd<sub>CT</sub> appears to be equivalent or superior to AVC and AVCd<sub>Echo</sub> to assess AS severity and predict all-cause mortality. Thus, it should be used to evaluate AS severity in patients with nonconclusive echocardiographic evaluations with or without low-flow status. AVCd<sub>CT</sub> thresholds of 300 AU/cm<sup>2</sup> for women and 500 AU/cm<sup>2</sup> for men seem to be appropriate to identify severe AS. Further studies are needed to validate these thresholds, especially in diverse populations.</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":null,"pages":null},"PeriodicalIF":6.5000,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Aortic Valve Calcification Density Measured by MDCT in the Assessment of Aortic Stenosis Severity.\",\"authors\":\"Andréanne Powers, Mulham Ali, Nicolas Lavoie, Amal Haujir, Nils Sofus Borg Mogensen, Sebastian Ludwig, Kristian Altern Øvrehus, Lionel Tastet, Catherine Rhéaume, Niklas Schofer, Jordi Sanchez Dahl, Marie-Annick Clavel\",\"doi\":\"10.1161/CIRCIMAGING.123.016267\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Aortic valve calcification (AVC) indexation to the aortic annulus (AA) area measured by Doppler echocardiography (AVCd<sub>Echo</sub>) provides powerful prognostic information in patients with aortic stenosis (AS). However, the indexation by AA measured by multidetector computed tomography (AVCd<sub>CT</sub>) has never been evaluated. The aim of this study was to compare AVC, AVCd<sub>CT</sub>, and AVCd<sub>Echo</sub> with regard to hemodynamic correlations and clinical outcomes in patients with AS.</p><p><strong>Methods: </strong>Data from 889 patients, mainly White, with calcific AS who underwent Doppler echocardiography and multidetector computed tomography within the same episode of care were retrospectively analyzed. AA was measured both by Doppler echocardiography and multidetector computed tomography. AVCd<sub>CT</sub> severity thresholds were established using receiver operating characteristic curve analyses in men and women separately. The primary end point was the occurrence of all-cause mortality.</p><p><strong>Results: </strong>Correlations between gradient/velocity and AVCd were stronger (both <i>P</i>≤0.005) using AVCd<sub>CT</sub> (r=0.68, <i>P</i><0.001 and r=0.66, <i>P</i><0.001) than AVC (r=0.61, <i>P</i><0.001 and r=0.60, <i>P</i><0.001) or AVCd<sub>Echo</sub> (r=0.61, <i>P</i><0.001 and r=0.59, <i>P</i><0.001). AVCd<sub>CT</sub> thresholds for the identification of severe AS were 334 Agatston units (AU)/cm<sup>2</sup> for women and 467 AU/cm<sup>2</sup> for men. On a median follow-up of 6.62 (6.19-9.69) years, AVCd<sub>CT</sub> ratio was superior to AVC ratio and AVCd<sub>Echo</sub> ratio to predict all-cause mortality in multivariate analyses (hazard ratio [HR], 1.59 [95% CI, 1.26-2.00]; <i>P</i><0.001 versus HR, 1.53 [95% CI, 1.11-1.65]; <i>P</i>=0.003 versus HR, 1.27 [95% CI, 1.11-1.46]; <i>P</i><0.001; all likelihood test <i>P</i>≤0.004). AVCd<sub>CT</sub> ratio was superior to AVC ratio and AVCd<sub>Echo</sub> ratio to predict survival under medical treatment in multivariate analyses (HR, 1.80 [95% CI, 1.27-1.58]; <i>P</i><0.001 compared with HR, 1.55 [95% CI, 1.13-2.10]; <i>P</i>=0.007; HR, 1.28 [95% CI, 1.03-1.57]; <i>P</i>=0.01; all likelihood test <i>P</i><0.03). AVCd<sub>CT</sub> ratio predicts mortality in all subgroups of patients with AS.</p><p><strong>Conclusions: </strong>AVCd<sub>CT</sub> appears to be equivalent or superior to AVC and AVCd<sub>Echo</sub> to assess AS severity and predict all-cause mortality. Thus, it should be used to evaluate AS severity in patients with nonconclusive echocardiographic evaluations with or without low-flow status. AVCd<sub>CT</sub> thresholds of 300 AU/cm<sup>2</sup> for women and 500 AU/cm<sup>2</sup> for men seem to be appropriate to identify severe AS. Further studies are needed to validate these thresholds, especially in diverse populations.</p>\",\"PeriodicalId\":10202,\"journal\":{\"name\":\"Circulation: Cardiovascular Imaging\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":6.5000,\"publicationDate\":\"2024-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Circulation: Cardiovascular Imaging\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1161/CIRCIMAGING.123.016267\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/5/21 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Circulation: Cardiovascular Imaging","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/CIRCIMAGING.123.016267","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/5/21 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Aortic Valve Calcification Density Measured by MDCT in the Assessment of Aortic Stenosis Severity.
Background: Aortic valve calcification (AVC) indexation to the aortic annulus (AA) area measured by Doppler echocardiography (AVCdEcho) provides powerful prognostic information in patients with aortic stenosis (AS). However, the indexation by AA measured by multidetector computed tomography (AVCdCT) has never been evaluated. The aim of this study was to compare AVC, AVCdCT, and AVCdEcho with regard to hemodynamic correlations and clinical outcomes in patients with AS.
Methods: Data from 889 patients, mainly White, with calcific AS who underwent Doppler echocardiography and multidetector computed tomography within the same episode of care were retrospectively analyzed. AA was measured both by Doppler echocardiography and multidetector computed tomography. AVCdCT severity thresholds were established using receiver operating characteristic curve analyses in men and women separately. The primary end point was the occurrence of all-cause mortality.
Results: Correlations between gradient/velocity and AVCd were stronger (both P≤0.005) using AVCdCT (r=0.68, P<0.001 and r=0.66, P<0.001) than AVC (r=0.61, P<0.001 and r=0.60, P<0.001) or AVCdEcho (r=0.61, P<0.001 and r=0.59, P<0.001). AVCdCT thresholds for the identification of severe AS were 334 Agatston units (AU)/cm2 for women and 467 AU/cm2 for men. On a median follow-up of 6.62 (6.19-9.69) years, AVCdCT ratio was superior to AVC ratio and AVCdEcho ratio to predict all-cause mortality in multivariate analyses (hazard ratio [HR], 1.59 [95% CI, 1.26-2.00]; P<0.001 versus HR, 1.53 [95% CI, 1.11-1.65]; P=0.003 versus HR, 1.27 [95% CI, 1.11-1.46]; P<0.001; all likelihood test P≤0.004). AVCdCT ratio was superior to AVC ratio and AVCdEcho ratio to predict survival under medical treatment in multivariate analyses (HR, 1.80 [95% CI, 1.27-1.58]; P<0.001 compared with HR, 1.55 [95% CI, 1.13-2.10]; P=0.007; HR, 1.28 [95% CI, 1.03-1.57]; P=0.01; all likelihood test P<0.03). AVCdCT ratio predicts mortality in all subgroups of patients with AS.
Conclusions: AVCdCT appears to be equivalent or superior to AVC and AVCdEcho to assess AS severity and predict all-cause mortality. Thus, it should be used to evaluate AS severity in patients with nonconclusive echocardiographic evaluations with or without low-flow status. AVCdCT thresholds of 300 AU/cm2 for women and 500 AU/cm2 for men seem to be appropriate to identify severe AS. Further studies are needed to validate these thresholds, especially in diverse populations.
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.