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Optimal threshold score of aortic valve calcification for identification of significant aortic stenosis on non-electrocardiographic-gated computed tomography

  • Cardiac
  • Published:
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Abstract

Objectives

This study evaluated the association between aortic valve calcification (AVC) and aortic stenosis (AS) by scoring the AVC to determine the threshold scores for significant AS on non-electrocardiographic (ECG)–gated computed tomography (CT).

Methods

We retrospectively analyzed the AVC scores of 5385 patients on non-contrast non-ECG-gated CT, who underwent transthoracic echocardiography (TTE) from March 1, 2013, to December 26, 2019, at our institution. Multivariable logistic regression models were used to identify potential risk factors for significant AS. The thresholds for significant AS were computed using receiver operator characteristic (ROC) curves, based on the AVC scores after propensity score matching.

Results

A significant association was found between AS and age (p < 0.001; odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02–1.06), female sex (p < 0.001; OR, 4.5; 95% CI, 2.75–7.36), bicuspid aortic valve (p < 0.001; OR, 23.2; 95% CI, 7.35–72.9), and AVC score (AVC score/100) (p < 0.001; OR, 1.82; 95% CI, 1.71–1.95). All sex-specific AVC thresholds for significant AS (moderate and over AS severity, moderate and over AS severity without discordance, discordant severe AS, and concordant severe AS) showed high sensitivity and specificity (AUC, 0.939–0.968; sensitivity, 84.6–96%; specificity, 84.2–97.1%).

Conclusions

We determined the optimal AVC threshold scores for significant AS, which may aid in diagnosing significant asymptomatic AS on incidental detection of AVC through non-ECG-gated CT for non-cardiac indications.

Key Points

• Increased frequency of non-electrocardiographic (ECG)–gated computed tomography (CT) for non-cardiac indications has led to the increased incidental identification of aortic valve calcification (AVC).

• It is important to identify patients with significant aortic stenosis (AS) who require additional echocardiographic assessment on incidental detection of AVC via non-ECG-gated CT.

• We determined the AVC thresholds with high sensitivity and specificity to identify significant AS on non-ECG-gated CT, which could lead to early diagnosis of asymptomatic significant AS and improved prognosis.

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Abbreviations

AS:

Aortic stenosis

AU:

Arbitrary units

AUC:

Area under the curve

AVA:

Aortic valve area

AVAi:

Aortic valve area indexed to the body surface area

AVC:

Aortic valve calcification

AVCi:

Aortic valve calcification indexed to the body surface area

BAV:

Bicuspid aortic valve

CI:

Confidence intervals

CKD:

Chronic kidney disease

CT:

Computed tomography

ECG:

Electrocardiography

EF:

Ejection fraction

ICC:

Intraclass correlation coefficients

MG:

Mean transvalvular gradient

OR:

Odds ratios

PSM:

Propensity score matching

ROC:

Receiver operator characteristic

SD:

Standard deviation

TTE:

Transthoracic echocardiography

VIF:

Variance inflation factor

Vmax:

Peak aortic jet velocity

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Acknowledgements

The authors are grateful to Tohru Sekiya, the former president of Nitobe Bunka College, for his insightful comments.

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan

    Kotaro Ouchi, Toru Sakuma, Rui Kano, Takahiro Higuchi, Hiroyuki Yakabe, Jun Hasumi, Takayuki Suzuki, Hiroaki Fujioka, Akira Ogihara, Syohei Yoshimoto, Takao Igarashi & Hiroya Ojiri

  2. Department of Laboratory Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan

    Ayumi Nojiri

  3. Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan

    Makoto Kawai

  4. Department of Cardiac Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan

    Yohkoh Matsumura, Michio Yoshitake & Takashi Kunihara

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  1. Kotaro Ouchi
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  2. Toru Sakuma
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Corresponding author

Correspondence to Kotaro Ouchi.

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Guarantor

The scientific guarantor of this publication is Kotaro Ouchi.

Conflict of interest

Makoto Kawai received research grants from DAIICHI SANKYO COMPANY, Ltd., Japan. The remaining authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and Biometry

One of the authors has significant statistical expertise.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

• retrospective

• case-control study

• performed at one institution

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Ouchi, K., Sakuma, T., Nojiri, A. et al. Optimal threshold score of aortic valve calcification for identification of significant aortic stenosis on non-electrocardiographic-gated computed tomography. Eur Radiol 33, 1243–1253 (2023). https://doi.org/10.1007/s00330-022-09114-6

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  • DOI: https://doi.org/10.1007/s00330-022-09114-6

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