Computed Tomography Aortic Valve Calcium Scoring in Patients With Bicuspid Aortic Valve Stenosis

Mylène Shen, PhD; Jin Kyung Oh, MD; Ezequiel Guzzetti, MD; Gurpreet K. Singh, MD; Tania Pawade, MD; Lionel Tastet, MSc; Marie-Annick Clavel, DVM, PhD; Victoria Delgado, MD; Jeroen J. Bax, MD; Marc R. Dweck, MD; Amr E. Abbas, MD; Ramy Mando, MD; Mariano Luis Falconi, MD; Diego Perez de Arenaza, MD; Kian Keong Poh, MD; William Kong, MD; Edgar Tay, MD; Gregg Pressman, MD; Daniel Brito, MD; Jae Kwan Song, MD; Philippe Pibarot, DVM, PhD

Structural Heart (Apr 2022)

Computed Tomography Aortic Valve Calcium Scoring in Patients With Bicuspid Aortic Valve Stenosis

Mylène Shen, PhD,
Jin Kyung Oh, MD,
Ezequiel Guzzetti, MD,
Gurpreet K. Singh, MD,
Tania Pawade, MD,
Lionel Tastet, MSc,
Marie-Annick Clavel, DVM, PhD,
Victoria Delgado, MD,
Jeroen J. Bax, MD,
Marc R. Dweck, MD,
Amr E. Abbas, MD,
Ramy Mando, MD,
Mariano Luis Falconi, MD,
Diego Perez de Arenaza, MD,
Kian Keong Poh, MD,
William Kong, MD,
Edgar Tay, MD,
Gregg Pressman, MD,
Daniel Brito, MD,
Jae Kwan Song, MD,
Philippe Pibarot, DVM, PhD

Affiliations

Mylène Shen, PhD: Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart & Lung Institute, Université Laval, Quebec City, Quebec, Canada
Jin Kyung Oh, MD: Division of Cardiology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Korea
Ezequiel Guzzetti, MD: Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart & Lung Institute, Université Laval, Quebec City, Quebec, Canada
Gurpreet K. Singh, MD: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Tania Pawade, MD: British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
Lionel Tastet, MSc: Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart & Lung Institute, Université Laval, Quebec City, Quebec, Canada
Marie-Annick Clavel, DVM, PhD: Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart & Lung Institute, Université Laval, Quebec City, Quebec, Canada
Victoria Delgado, MD: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Jeroen J. Bax, MD: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Marc R. Dweck, MD: British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
Amr E. Abbas, MD: Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, Michigan, USA
Ramy Mando, MD: Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, Michigan, USA
Mariano Luis Falconi, MD: Department of Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Diego Perez de Arenaza, MD: Department of Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Kian Keong Poh, MD: Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
William Kong, MD: Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
Edgar Tay, MD: Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
Gregg Pressman, MD: Department of Cardiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA
Daniel Brito, MD: Department of Cardiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA
Jae Kwan Song, MD: Valvular Heart Disease Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Korea
Philippe Pibarot, DVM, PhD: Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart & Lung Institute, Université Laval, Quebec City, Quebec, Canada; Address correspondence to: Philippe Pibarot, DVM, PhD, Institut Universitaire de Cardiologie et de Pneumologie de Québec (Quebec Heart & Lung Institute), 2725 Chemin Sainte-Foy, Quebec City, Quebec G1V 4G5, Canada

Journal volume & issue: Vol. 6, no. 1
p. 100027

Abstract

Read online

Background: Sex-specific thresholds of computed tomography (CT)–derived aortic valve calcification (AVC) or AVC density (AVCd) to identify severe aortic stenosis (AS) have been established in populations that consisted mainly of Caucasians with a tricuspid aortic valve. The objective of this study was to evaluate the accuracy (i.e., sensitivity and specificity) of previously established thresholds to identify severe AS in patients with bicuspid aortic valve (BAV) and according to ethnicity: Caucasian vs. Asian. Methods: We built a multicenter registry of echocardiographic and CT data collected in BAV patients with at least mild AS and preserved left ventricular ejection fraction from 7 different centers. Anatomic severity of AS obtained by CT-derived AVC and AVCd was compared to hemodynamic severity of AS obtained by echocardiography. Results: Among 485 BAV patients (60% men, 73% Asians), the best thresholds of AVC and AVCd to identify severe AS in BAV patients were 2315 arbitrary units (AU) (sensitivity [Se]/specificity [Spe] = 82/78%) in men, 1103 AU (Se/Spe = 80/82%) in women, and 561 AU/cm2 (Se/Spe = 86/91%) in men, and 301 AU/cm2 (Se/Spe = 83/82%) in women, respectively. According to ethnicity, thresholds for severe AS in Caucasian patients were, respectively, in men and women: 2208 AU (Se/Spe = 83/83%) and 1230 AU (Se/Spe = 87/82%) for AVC and 474 AU/cm2 (Se/Spe = 88/83%) and 358 AU/cm2 (Se/Spe = 80/82%) for AVCd. In Asian patients, they were 2582 AU (Se/Spe = 76/78%) and 924 AU (Se/Spe = 84/80%) for AVC and 640 AU/cm2 (Se/Spe = 82/89%) and 255 AU/cm2 (Se/Spe = 86/80%) for AVCd. Conclusions: The optimal thresholds to identify hemodynamically severe AS in BAV patients are similar in Caucasians but appear to be higher in Asian men, compared with thresholds previously reported in tricuspid aortic valve patients. Nonetheless, the thresholds currently proposed in the guidelines have good accuracy and can be applied in BAV patients to confirm AS severity.

Published in Structural Heart

ISSN: 2474-8706 (Print); 2474-8714 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system
Website: https://www.sciencedirect.com/journal/structural-heart

About the journal

Abstract

Keywords