Abstract
The diagnostic value of a visual assessment of aortic valve (AV) morphology for grading aortic stenosis (AS) remains unclear. A visual score (VS) for assessing the AV was developed and its reliability with respect to Doppler measurements and the calcium score (ctCS) derived by multislice computed tomography was evaluated. 99 Patients with AS of various severity and 38 patients without AS were included in the analysis. Echocardiographic studies were evaluated using the new VS which includes echogenicity, thickening, localization of lesions and leaflet mobility, with a total score ranging from 0 to 11. The association of VS with ctCS and the severity of AS was analyzed. There was a significant correlation of VS with AV hemodynamic parameters and with ctCS. The cut-off value for the detection of AS of any grade was a VS of 6 (sensitivity 95%, specificity 85% for women; sensitivity 85%, specificity 88% for men). A VS of 9 for women and of 10 for men was able to predict severe AS with a high specificity (96% in women and 94% in men, AUC 0.8 and 0.86, respectively). The same cut-off values were identified for the detection of ctCS of ≥ 1600 AU and ≥ 3000 AU with a specificity of 77% and 82% (AUC 0.69 and 0.81, respectively). Assessment of aortic valve morphology can serve as an additional diagnostic tool for the detection of AS and an estimation of its severity.
Highlights
Aortic stenosis (AS) is the most common valve disease, with a prevalence of 1.7% in people aged over 65 years and 3.4% in people aged over 75 years in North America and Europe [1]
aortic valve (AV) calcification is associated with aortic stenosis (AS) severity and can be assessed by multislice computed tomography, MSCT [3], with a lower degree of AV calcification in women compared to men for the same severity of AS [4, 5]
Whenever MSCT was indicated in the clinical setting, the data were used for our analysis provided that less than 3 months had passed between the echocardiography and MSCT
Summary
Aortic stenosis (AS) is the most common valve disease, with a prevalence of 1.7% in people aged over 65 years and 3.4% in people aged over 75 years in North America and Europe [1]. Around 30% of patients present with inconsistent echocardiographic findings [7, 8]. In these patients, grading of AS by Doppler measurements alone can be difficult and might require additional tests [8]. The assessment of AV calcification by MSCT is an important complementary approach [9]. It is already implemented in the guidelines for the assessment of patients with low-flow, low-gradient AS [10]. AV calcium load measured by MSCT has been shown to be of prognostic relevance in the natural course of AS [3,4,5] and in patients treated with percutaneous aortic valve replacement [11]
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