Measurement of aortic valve calcification using multislice computed tomography: Correlation with haemodynamic severity of aortic stenosis and clinical implication for patients with low ejection fraction

Caroline Cueff, Jean Michel Serfaty, Claire Cimadevilla, Jean Pierre Laissy, Dominique Himbert, Florence Tubach, Xavier Duval, Bernard Iung, Maurice E Sarano, Alec Vahanian, David Messika-Zeitoun

Research output: Contribution to journalArticle

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Abstract

Background Measurement of the degree of aortic valve calcification (AVC) using electron beam computed tomography (EBCT) is an accurate and complementary method to transthoracic echocardiography (TTE) for assessment of the severity of aortic stenosis (AS). Whether threshold values of AVC obtained with EBCT could be extrapolated to multislice computed tomography (MSCT) was unclear and AVC diagnostic value in patients with low ejection fraction (EF) has never been specifically evaluated. Methods Patients with mild to severe AS underwent prospectively within 1 week MSCT and TTE. Severe AS was defined as an aortic valve area (AVA) of less than 1 cm2. In 179 patients with EF greater than 40% (validation set), the relationship between AVC and AVA was evaluated. The best threshold of AVC for the diagnosis of severe AS was then evaluated in a second subset (testing set) of 49 patients with low EF (#40%). In this subgroup, AS severity was defined based on mean gradient, natural history or dobutamine stress echocardiography. Results Correlation between AVC and AVA was good (r=-0.63, p<0.0001). A threshold of 1651 arbitrary units (AU) provided 82% sensitivity, 80% specificity, 88% negative-predictive value and 70% positive-predictive value. In the testing set (patients with low EF), this threshold correctly differentiated patients with severe AS from non-severe AS in all but three cases. These three patients had an AVC score close to the threshold (1206, 1436 and 1797 AU). Conclusions In this large series of patients with a wide range of AS, AVC was shown to be well correlated to AVA and may be a useful adjunct for the evaluation of AS severity especially in difficult cases such as patients with low EF.

Original languageEnglish (US)
Pages (from-to)721-726
Number of pages6
JournalHeart
Volume97
Issue number9
DOIs
StatePublished - May 2011

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Multidetector Computed Tomography
Aortic Valve Stenosis
Hemodynamics
Aortic Valve
X Ray Computed Tomography
Echocardiography
Calcification of Aortic Valve
Stress Echocardiography
Natural History
Sensitivity and Specificity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Measurement of aortic valve calcification using multislice computed tomography : Correlation with haemodynamic severity of aortic stenosis and clinical implication for patients with low ejection fraction. / Cueff, Caroline; Serfaty, Jean Michel; Cimadevilla, Claire; Laissy, Jean Pierre; Himbert, Dominique; Tubach, Florence; Duval, Xavier; Iung, Bernard; Sarano, Maurice E; Vahanian, Alec; Messika-Zeitoun, David.

In: Heart, Vol. 97, No. 9, 05.2011, p. 721-726.

Research output: Contribution to journalArticle

Cueff, Caroline ; Serfaty, Jean Michel ; Cimadevilla, Claire ; Laissy, Jean Pierre ; Himbert, Dominique ; Tubach, Florence ; Duval, Xavier ; Iung, Bernard ; Sarano, Maurice E ; Vahanian, Alec ; Messika-Zeitoun, David. / Measurement of aortic valve calcification using multislice computed tomography : Correlation with haemodynamic severity of aortic stenosis and clinical implication for patients with low ejection fraction. In: Heart. 2011 ; Vol. 97, No. 9. pp. 721-726.
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abstract = "Background Measurement of the degree of aortic valve calcification (AVC) using electron beam computed tomography (EBCT) is an accurate and complementary method to transthoracic echocardiography (TTE) for assessment of the severity of aortic stenosis (AS). Whether threshold values of AVC obtained with EBCT could be extrapolated to multislice computed tomography (MSCT) was unclear and AVC diagnostic value in patients with low ejection fraction (EF) has never been specifically evaluated. Methods Patients with mild to severe AS underwent prospectively within 1 week MSCT and TTE. Severe AS was defined as an aortic valve area (AVA) of less than 1 cm2. In 179 patients with EF greater than 40{\%} (validation set), the relationship between AVC and AVA was evaluated. The best threshold of AVC for the diagnosis of severe AS was then evaluated in a second subset (testing set) of 49 patients with low EF (#40{\%}). In this subgroup, AS severity was defined based on mean gradient, natural history or dobutamine stress echocardiography. Results Correlation between AVC and AVA was good (r=-0.63, p<0.0001). A threshold of 1651 arbitrary units (AU) provided 82{\%} sensitivity, 80{\%} specificity, 88{\%} negative-predictive value and 70{\%} positive-predictive value. In the testing set (patients with low EF), this threshold correctly differentiated patients with severe AS from non-severe AS in all but three cases. These three patients had an AVC score close to the threshold (1206, 1436 and 1797 AU). Conclusions In this large series of patients with a wide range of AS, AVC was shown to be well correlated to AVA and may be a useful adjunct for the evaluation of AS severity especially in difficult cases such as patients with low EF.",
author = "Caroline Cueff and Serfaty, {Jean Michel} and Claire Cimadevilla and Laissy, {Jean Pierre} and Dominique Himbert and Florence Tubach and Xavier Duval and Bernard Iung and Sarano, {Maurice E} and Alec Vahanian and David Messika-Zeitoun",
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T1 - Measurement of aortic valve calcification using multislice computed tomography

T2 - Correlation with haemodynamic severity of aortic stenosis and clinical implication for patients with low ejection fraction

AU - Cueff, Caroline

AU - Serfaty, Jean Michel

AU - Cimadevilla, Claire

AU - Laissy, Jean Pierre

AU - Himbert, Dominique

AU - Tubach, Florence

AU - Duval, Xavier

AU - Iung, Bernard

AU - Sarano, Maurice E

AU - Vahanian, Alec

AU - Messika-Zeitoun, David

PY - 2011/5

Y1 - 2011/5

N2 - Background Measurement of the degree of aortic valve calcification (AVC) using electron beam computed tomography (EBCT) is an accurate and complementary method to transthoracic echocardiography (TTE) for assessment of the severity of aortic stenosis (AS). Whether threshold values of AVC obtained with EBCT could be extrapolated to multislice computed tomography (MSCT) was unclear and AVC diagnostic value in patients with low ejection fraction (EF) has never been specifically evaluated. Methods Patients with mild to severe AS underwent prospectively within 1 week MSCT and TTE. Severe AS was defined as an aortic valve area (AVA) of less than 1 cm2. In 179 patients with EF greater than 40% (validation set), the relationship between AVC and AVA was evaluated. The best threshold of AVC for the diagnosis of severe AS was then evaluated in a second subset (testing set) of 49 patients with low EF (#40%). In this subgroup, AS severity was defined based on mean gradient, natural history or dobutamine stress echocardiography. Results Correlation between AVC and AVA was good (r=-0.63, p<0.0001). A threshold of 1651 arbitrary units (AU) provided 82% sensitivity, 80% specificity, 88% negative-predictive value and 70% positive-predictive value. In the testing set (patients with low EF), this threshold correctly differentiated patients with severe AS from non-severe AS in all but three cases. These three patients had an AVC score close to the threshold (1206, 1436 and 1797 AU). Conclusions In this large series of patients with a wide range of AS, AVC was shown to be well correlated to AVA and may be a useful adjunct for the evaluation of AS severity especially in difficult cases such as patients with low EF.

AB - Background Measurement of the degree of aortic valve calcification (AVC) using electron beam computed tomography (EBCT) is an accurate and complementary method to transthoracic echocardiography (TTE) for assessment of the severity of aortic stenosis (AS). Whether threshold values of AVC obtained with EBCT could be extrapolated to multislice computed tomography (MSCT) was unclear and AVC diagnostic value in patients with low ejection fraction (EF) has never been specifically evaluated. Methods Patients with mild to severe AS underwent prospectively within 1 week MSCT and TTE. Severe AS was defined as an aortic valve area (AVA) of less than 1 cm2. In 179 patients with EF greater than 40% (validation set), the relationship between AVC and AVA was evaluated. The best threshold of AVC for the diagnosis of severe AS was then evaluated in a second subset (testing set) of 49 patients with low EF (#40%). In this subgroup, AS severity was defined based on mean gradient, natural history or dobutamine stress echocardiography. Results Correlation between AVC and AVA was good (r=-0.63, p<0.0001). A threshold of 1651 arbitrary units (AU) provided 82% sensitivity, 80% specificity, 88% negative-predictive value and 70% positive-predictive value. In the testing set (patients with low EF), this threshold correctly differentiated patients with severe AS from non-severe AS in all but three cases. These three patients had an AVC score close to the threshold (1206, 1436 and 1797 AU). Conclusions In this large series of patients with a wide range of AS, AVC was shown to be well correlated to AVA and may be a useful adjunct for the evaluation of AS severity especially in difficult cases such as patients with low EF.

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U2 - 10.1136/hrt.2010.198853

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