Aortic valve calcification is subject to aortic stenosis severity and the underlying flow pattern

Sex- and flow-related aortic valve calcification (AVC) studies are still limited in number, and data on the exact calcium quantity and distribution are scarce. Therefore, we aimed to (1) re-define the best threshold of AVC load to distinguish severe from moderate aortic stenosis (AS) in common AS en...

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Bibliographic Details
Published in:Heart and vessels 2021-02, Vol.36 (2), p.242-251
Main Authors: Veulemans, Verena, Piayda, Kerstin, Maier, Oliver, Bosbach, Georg, Polzin, Amin, Hellhammer, Katharina, Afzal, Shazia, Klein, Kathrin, Dannenberg, Lisa, Zako, Saif, Jung, Christian, Westenfeld, Ralf, Kelm, Malte, Zeus, Tobias
Format: Article
Language:English
Subjects:
Aorta
Aortic stenosis
Aortic valve
Biomedical Engineering and Bioengineering
Calcification
Calcification (ectopic)
Calcium
Cardiac Surgery
Cardiology
Degeneration
Gender
Heart
Heart valves
Medicine
Medicine & Public Health
Men
Original
Original Article
Regression analysis
Stenosis
Vascular Surgery
Ventricle
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Summary:Sex- and flow-related aortic valve calcification (AVC) studies are still limited in number, and data on the exact calcium quantity and distribution are scarce. Therefore, we aimed to (1) re-define the best threshold of AVC load to distinguish severe from moderate aortic stenosis (AS) in common AS entities and to (2) evaluate differences in the aortic annulus and left ventricular outflow tract (LVOT) calcium load. Nine hundred and thirty-eight patients with contrast-enhanced cardiac MSCT and moderate-to-severe aortic stenosis (AS) were retrospectively enrolled. Patients with severe AS ≤ 1.0 cm 2 ( n  = 841) were further separated into three AS entities: high gradient (HGAS, n  = 370, 44.0%), paradoxical low gradient (pLGAS, n  = 333, 39.6%), and classical low gradient (LGAS, n  = 138, 16.4%). AVC, leaflet, and LVOT calcification were quantified. Aortic valve calcification scores were highest in severe HGAS, and lower in severe pLGAS and classical LGAS. In all severity and AS entities, the non-coronary cusp (NCC) was the most calcified one. LVOT calcification was consistently comparable between gender and AS entities. Accuracy of logistic regression was the highest in HGAS (male vs. female: AVC > 2156 Agatston units (AU), c-index 0.76; vs. AVC > 1292 AU, c-index 0.85; or AVC density > 406 AU/cm 2 , c-index 0.82; vs. > 259 AU/cm 2 , c-index 0.86; each p  
ISSN:0910-8327
1615-2573
DOI:10.1007/s00380-020-01688-9