Grading of Aortic Valve Calcification Severity and Risk Stratification in Aortic Stenosis
Background Thresholds of aortic valve calcification (AVC) to define hemodynamically moderate aortic stenosis (AS) from mild are lacking. We aimed to establish a novel grading classification of AVC as quantified by computed tomography and determine its prognostic value. Methods and Results This study...
Saved in:
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2024-08-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.035605 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850146708251475968 |
|---|---|
| author | Lionel Tastet Mulham Ali Philippe Pibarot Romain Capoulade Kristian Altern Øvrehus Marie Arsenault Amal Haujir Élisabeth Bédard Axel Cosmus Pyndt Diederichsen Jordi S. Dahl Marie‐Annick Clavel |
| author_facet | Lionel Tastet Mulham Ali Philippe Pibarot Romain Capoulade Kristian Altern Øvrehus Marie Arsenault Amal Haujir Élisabeth Bédard Axel Cosmus Pyndt Diederichsen Jordi S. Dahl Marie‐Annick Clavel |
| author_sort | Lionel Tastet |
| collection | DOAJ |
| description | Background Thresholds of aortic valve calcification (AVC) to define hemodynamically moderate aortic stenosis (AS) from mild are lacking. We aimed to establish a novel grading classification of AVC as quantified by computed tomography and determine its prognostic value. Methods and Results This study included 915 patients with at least mild AS (mean age 70±12 years, 30% women) from a multicenter prospective registry. All patients underwent Doppler‐echocardiography and noncontrast computed tomography within 3 months. Primary end point was the occurrence of all‐cause death. Receiver operating characteristic curves analyses were used to determine the sensitivity and specificity of sex‐specific thresholds of AVC to identify hemodynamically moderate AS. Optimal thresholds (ie, with best sensitivity/specificity) of AVC to distinguish moderate (aortic valve area 1.0–1.5 cm2 and mean gradient 20–39 mm Hg) from mild AS (aortic valve area >1.5 cm2 and mean gradient <20 mm Hg) were AVC ≥360 arbitrary units in women and ≥1037 arbitrary units in men. Based on the guidelines' thresholds for severe AS and the new thresholds in our study for moderate AS, 312 (34%) patients had mild, 253 (28%) moderate, and 350 (38%) severe AVC. During a mean follow‐up of 5.6±3.9 years, 183 (27%) deaths occurred. In Cox multivariable models, AVC remained associated with an increased risk of death (adjusted hazard ratio per grade increase, 1.94 [95% CI, 1.53–2.56]; P<0.001). Conclusions A novel grading classification of anatomic AS severity based on sex‐specific thresholds of AVC provides significant prognostic value for predicting mortality. These findings support the complementarity of computed tomography‐calcium scoring to Doppler‐echocardiography to corroborate AS severity and enhance risk stratification in patients with AS. |
| format | Article |
| id | doaj-art-b0b8a01bd1334a458bfeb4c2ea4dbb53 |
| institution | OA Journals |
| issn | 2047-9980 |
| language | English |
| publishDate | 2024-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-b0b8a01bd1334a458bfeb4c2ea4dbb532025-08-20T02:27:46ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-08-01131510.1161/JAHA.123.035605Grading of Aortic Valve Calcification Severity and Risk Stratification in Aortic StenosisLionel Tastet0Mulham Ali1Philippe Pibarot2Romain Capoulade3Kristian Altern Øvrehus4Marie Arsenault5Amal Haujir6Élisabeth Bédard7Axel Cosmus Pyndt Diederichsen8Jordi S. Dahl9Marie‐Annick Clavel10Institut universitaire de cardiologie et de pneumologie de Québec Université Laval Québec City Québec CanadaDepartment of Cardiology Odense University Hospital Odense DenmarkInstitut universitaire de cardiologie et de pneumologie de Québec Université Laval Québec City Québec CanadaNantes Université, CHU Nantes, CNRS, INSERM, l’institut du thorax Nantes FranceDepartment of Cardiology Odense University Hospital Odense DenmarkInstitut universitaire de cardiologie et de pneumologie de Québec Université Laval Québec City Québec CanadaDepartment of Cardiology Odense University Hospital Odense DenmarkInstitut universitaire de cardiologie et de pneumologie de Québec Université Laval Québec City Québec CanadaDepartment of Cardiology Odense University Hospital Odense DenmarkDepartment of Cardiology Odense University Hospital Odense DenmarkInstitut universitaire de cardiologie et de pneumologie de Québec Université Laval Québec City Québec CanadaBackground Thresholds of aortic valve calcification (AVC) to define hemodynamically moderate aortic stenosis (AS) from mild are lacking. We aimed to establish a novel grading classification of AVC as quantified by computed tomography and determine its prognostic value. Methods and Results This study included 915 patients with at least mild AS (mean age 70±12 years, 30% women) from a multicenter prospective registry. All patients underwent Doppler‐echocardiography and noncontrast computed tomography within 3 months. Primary end point was the occurrence of all‐cause death. Receiver operating characteristic curves analyses were used to determine the sensitivity and specificity of sex‐specific thresholds of AVC to identify hemodynamically moderate AS. Optimal thresholds (ie, with best sensitivity/specificity) of AVC to distinguish moderate (aortic valve area 1.0–1.5 cm2 and mean gradient 20–39 mm Hg) from mild AS (aortic valve area >1.5 cm2 and mean gradient <20 mm Hg) were AVC ≥360 arbitrary units in women and ≥1037 arbitrary units in men. Based on the guidelines' thresholds for severe AS and the new thresholds in our study for moderate AS, 312 (34%) patients had mild, 253 (28%) moderate, and 350 (38%) severe AVC. During a mean follow‐up of 5.6±3.9 years, 183 (27%) deaths occurred. In Cox multivariable models, AVC remained associated with an increased risk of death (adjusted hazard ratio per grade increase, 1.94 [95% CI, 1.53–2.56]; P<0.001). Conclusions A novel grading classification of anatomic AS severity based on sex‐specific thresholds of AVC provides significant prognostic value for predicting mortality. These findings support the complementarity of computed tomography‐calcium scoring to Doppler‐echocardiography to corroborate AS severity and enhance risk stratification in patients with AS.https://www.ahajournals.org/doi/10.1161/JAHA.123.035605aortic stenosisaortic valve calcificationsex differences |
| spellingShingle | Lionel Tastet Mulham Ali Philippe Pibarot Romain Capoulade Kristian Altern Øvrehus Marie Arsenault Amal Haujir Élisabeth Bédard Axel Cosmus Pyndt Diederichsen Jordi S. Dahl Marie‐Annick Clavel Grading of Aortic Valve Calcification Severity and Risk Stratification in Aortic Stenosis Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease aortic stenosis aortic valve calcification sex differences |
| title | Grading of Aortic Valve Calcification Severity and Risk Stratification in Aortic Stenosis |
| title_full | Grading of Aortic Valve Calcification Severity and Risk Stratification in Aortic Stenosis |
| title_fullStr | Grading of Aortic Valve Calcification Severity and Risk Stratification in Aortic Stenosis |
| title_full_unstemmed | Grading of Aortic Valve Calcification Severity and Risk Stratification in Aortic Stenosis |
| title_short | Grading of Aortic Valve Calcification Severity and Risk Stratification in Aortic Stenosis |
| title_sort | grading of aortic valve calcification severity and risk stratification in aortic stenosis |
| topic | aortic stenosis aortic valve calcification sex differences |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.035605 |
| work_keys_str_mv | AT lioneltastet gradingofaorticvalvecalcificationseverityandriskstratificationinaorticstenosis AT mulhamali gradingofaorticvalvecalcificationseverityandriskstratificationinaorticstenosis AT philippepibarot gradingofaorticvalvecalcificationseverityandriskstratificationinaorticstenosis AT romaincapoulade gradingofaorticvalvecalcificationseverityandriskstratificationinaorticstenosis AT kristianalternøvrehus gradingofaorticvalvecalcificationseverityandriskstratificationinaorticstenosis AT mariearsenault gradingofaorticvalvecalcificationseverityandriskstratificationinaorticstenosis AT amalhaujir gradingofaorticvalvecalcificationseverityandriskstratificationinaorticstenosis AT elisabethbedard gradingofaorticvalvecalcificationseverityandriskstratificationinaorticstenosis AT axelcosmuspyndtdiederichsen gradingofaorticvalvecalcificationseverityandriskstratificationinaorticstenosis AT jordisdahl gradingofaorticvalvecalcificationseverityandriskstratificationinaorticstenosis AT marieannickclavel gradingofaorticvalvecalcificationseverityandriskstratificationinaorticstenosis |