Journal article
Diagnostic Value of Aortic Valve Calcification Levels in the Assessment of Low-Gradient Aortic Stenosis
JACC. Cardiovascular imaging, Vol.17(8), pp.847-860
08/01/2024
DOI: 10.1016/j.jcmg.2024.03.014
PMID: 38795109
Abstract
In patients with low-gradient aortic stenosis (AS) and low transvalvular flow, dobutamine stress echocardiography (DSE) is recommended to determine AS severity, whereas the degree of aortic valve calcification (AVC) supposedly correlates with AS severity according to current European and American guidelines.
The purpose of this study was to assess the relationship between AVC and AS severity as determined using echocardiography and DSE in patients with aortic valve area <1 cm2 and peak aortic valve velocity <4.0 m/s.
All patients underwent DSE to determine AS severity and multislice computed tomography to quantify AVC. Receiver-operating characteristics curve analysis was used to assess the diagnostic value of AVC for AS severity grading as determined using echocardiography and DSE in men and women.
A total of 214 patients were included. Median age was 78 years (25th-75th percentile: 71-84 years) and 25% were women. Left ventricular ejection fraction was reduced (<50%) in 197 (92.1%) patients. Severe AS was diagnosed in 106 patients (49.5%). Moderate AS was diagnosed in 108 patients (50.5%; in 77 based on resting transthoracic echocardiography, in 31 confirmed using DSE). AVC score was high (≥2,000 for men or ≥1,200 for women) in 47 (44.3%) patients with severe AS and in 47 (43.5%) patients with moderate AS. AVC sensitivity was 44.3%, specificity was 56.5%, and positive and negative predictive values for severe AS were 50.0% and 50.8%, respectively. Area under the receiver-operating characteristics curve was 0.508 for men and 0.524 for women.
Multi-slice computed tomography–derived AVC scores showed poor discrimination between grades of AS severity using DSE and cannot replace DSE in the diagnostic work-up of low-gradient severe AS.
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Details
- Title: Subtitle
- Diagnostic Value of Aortic Valve Calcification Levels in the Assessment of Low-Gradient Aortic Stenosis
- Creators
- Marcel L. Geleijnse - Erasmus MCSarah Verhemel - Erasmus MCMark M.P. Van den Dorpel - Erasmus MCIsabella Kardys - Erasmus MCPim A.L. Tonino - Catharina ZiekenhuisSu Min Chang - Houston MethodistNadeen N. Faza - Houston MethodistStephanie Jou - Icahn School of Medicine at Mount SinaiHiroki A. Ueyama - Icahn School of Medicine at Mount SinaiJoanna Bartkowiak - Columbia University Irving Medical CenterPhilippe B. Bertrand - Ziekenhuis Oost-LimburgTobias Zeus - Heinrich Heine University DüsseldorfRik Adrichem - Erasmus MCRebecca T. Hahn - Columbia University Irving Medical CenterThijmen W. Hokken - Erasmus MCJeroen J. Bax - Leiden University Medical CenterSusheel K. Kodali - Columbia University Irving Medical CenterSjoerd Bouwmeester - Radboud University NijmegenOla Abdelkarim - Houston MethodistStamatios Lerakis - Icahn School of Medicine at Mount SinaiBirgit Vogel - Icahn School of Medicine at Mount SinaiRoxana Mehran - Icahn School of Medicine at Mount SinaiDavid I. Blusztein - NewYork–Presbyterian HospitalStephen H. Little - Houston MethodistVerena Veulemans - Heinrich Heine University DüsseldorfPatrick Houthuizen - Radboud University NijmegenJurrien H. Kuneman - Leiden University Medical CenterNicolas M. Van Mieghem - Erasmus MC
- Resource Type
- Journal article
- Publication Details
- JACC. Cardiovascular imaging, Vol.17(8), pp.847-860
- DOI
- 10.1016/j.jcmg.2024.03.014
- PMID
- 38795109
- NLM abbreviation
- JACC Cardiovasc Imaging
- ISSN
- 1936-878X
- eISSN
- 1876-7591
- Publisher
- Elsevier Inc; NEW YORK
- Number of pages
- 14
- Grant note
- AstraZeneca, E.R. SquibbVecturaDura BiotechEdwards LifesciencesMedtronicJenaValveBaylis MedicalPhilips HealthcareSiemens HealthcareBoston ScientificBayer AGEdwards Life sciences
Dr Van Mieghem has received grant support/research contracts from Abbott Vascular, Boston Scientific, Medtronic, Edwards Lifesciences, Daiichy Sankyo, AstraZeneca, and PulseCath BV; and has received consulting/speaker fees from Abbot Vascular, Boston Scientific Corporation, Medtronic, Daiichy Sankyo, PulseCath BV, JenaValve, and Amgen. Dr Mehran has received grant support/research contracts from Abbott, Abiomed, Allevi ant Medical, Amgen, AM-Pharma, Arena Pharmaceuticals, AstraZeneca, Atricure Inc, Biosensors, Biotronik, Boston Scientific, Bristol-Myers Squibb, CardiaWave, CeloNova, Chiesi, Concept Medical, Cytsorbents, Daiichy-Sankyo, Element Science, Faraday, Humacyte, Idorsia Pharmaceuticals, Janssen Pharmaceuticals, Magenta, MedAlliance, Mediasphere, Medtelligence, Medtronic, MJH Healthcare, Novartis, OrbusNeich, Penumbra, PhaseBio, Philips, Pi-Cardia, PLx Pharma, Protembis, RenalPro, RM Global, Shockwave Medical, Vivasure, and Zoll; has received consulting/speaker fees from AstraZeneca, E.R. Squibb and Sons LLC, Esper ion Science/Innovativa Biopharma, Ionis Pharmaceuticals, IQVI A, J-Calc, McVeigh Global, Novartis, Novo Nordisk, Overcome, Primer Healthcare of New Jersey, Radcliffe, SL Solutions, TARSUS Cardiology, Vectura, and WebMD; and she has equity in Applied Therapeutics, Elixir, and STEL. Dr Mehran's spouse has equity in ControlRad. Dr Kodali has received grant support/research contracts from Admedus, Dura Biotech, Edwards Lifesciences, Medtronic, Abbott Vascular, Boston Scientific, and JenaValve; has received consulting/speaker fees from Admedus, Dura Biotech, TriCares, X-Dot, Tioga, Helix Valve Repair, and Moray Medical; and has equity in Dura Biotech, Microinterventional Devices, Thubrika Aortic Valve Inc, Supira, Admedus, Triflo, and Adona. Dr Hahn has received consulting/speaker fees from Abbott Structural, Medtronic, Edwards Lifesciences, Boston Scientific, Baylis Medical, Navigate, Philips Healthcare, Siemens Healthcare, and 3mensio; and has equity in Navigate. Dr Bax has received grant support/research contracts from Biotronic, Boston Scientific, Medtronic, Bayer AG, and Edwards Lifesciences; and has received consulting/speaker fees from Abbott Vascular and Edwards Life sciences. Drs Veulemans and Zeus have received consulting fees, travel expenses, or study honoraria from Medtronic, Edwards Lifesciences, and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.r consulting/speaker fees from AstraZeneca, E.R. Squibb and Sons LLC, Esper ion Science/Innovativa Biopharma, Ionis Pharmaceuticals, IQVI A, J-Calc, McVeigh Global, Novartis, Novo Nordisk, Overcome, Primer Healthcare of New Jersey, Radcliffe, SL Solutions, TARSUS Cardiology, Vectura, and WebMD; and she has equity in Applied Therapeutics, Elixir, and STEL. Dr Mehran's spouse has equity in ControlRad. Dr Kodali has received grant support/research contracts from Admedus, Dura Biotech, Edwards Lifesciences, Medtronic, Abbott Vascular, Boston Scientific, and JenaValve; has received consulting/speaker fees from Admedus, Dura Biotech, TriCares, X-Dot, Tioga, Helix Valve Repair, and Moray Medical; and has equity in Dura Biotech, Microinterventional Devices, Thubrika Aortic Valve Inc, Supira, Admedus, Triflo, and Adona. Dr Hahn has received consulting/speaker fees from Abbott Structural, Medtronic, Edwards Lifesciences, Boston Scientific, Baylis Medical, Navigate, Philips Healthcare, Siemens Healthcare, and 3mensio; and has equity in Navigate. Dr Bax has received grant support/research contracts from Biotronic, Boston Scientific, Medtronic, Bayer AG, and Edwards Lifesciences; and has received consulting/speaker fees from Abbott Vascular and Edwards Life sciences. Drs Veulemans and Zeus have received consulting fees, travel expenses, or study honoraria from Medtronic, Edwards Lifesciences, and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Language
- English
- Date published
- 08/01/2024
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984756260602771
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