Liu Franklin, Coursey Courtney A, Grahame-Clarke Cairistine, Sciacca Robert R, Rozenshtein Anna, Homma Shunichi, Austin John H M
Department of Radiology, Columbia University Medical Center, 630 W 168th St., New York, NY 10032, USA.
AJR Am J Roentgenol. 2006 Feb;186(2):342-9. doi: 10.2214/AJR.04.1366.
The purpose of this study was to correlate the severity and location of aortic valve calcifications, as an incidental finding at chest CT of elderly persons, with pressure gradients across the valve.
One hundred fifteen subjects who were 60 years old or older and who showed aortic valve calcification on chest CT (5-mm reconstructed section width, no IV contrast material) and who had also undergone transthoracic echocardiography within 3 months of the CT examination were identified retrospectively. Aortic valve calcification scores (Agatston and volumetric) and subjective calcification pattern scores (based on a 9-point scale) were calculated and correlated with echocardiographic gradients.
Thirty patients (26%) (median age, 81 years) were identified who showed an increased pressure gradient across the aortic valve at echocardiography. Eighty-five subjects (74%), including 30 age-matched but otherwise randomly selected control subjects, showed no increase in pressure gradient. The severity of aortic valve calcification was greater for the 30 subjects with an increased gradient than for the control subjects (p < 0.0001). Increased mean and peak gradients across the aortic valve correlated with the subjective scores for aortic valve calcification (r = 0.69 and 0.65, respectively; p < 0.0001), with Agatston scores (r = 0.76 and 0.70, respectively; p < 0.0001), and with volumetric scores (r = 0.78 and 0.73, respectively; p < 0.0001). In terms of specific commissures, the greatest correlation with mean and peak gradients was for peripheral left-posterior commissural calcification (r = 0.71 and 0.65, respectively; p < 0.0001) and central right-left commissural calcification (r = 0.69 and 0.66, respectively; p < 0.0001).
The severity of aortic valve calcifications on chest CT, as assessed either subjectively or objectively, correlated with increased pressure gradients across the aortic valve, particularly for calcification of the peripheral left-posterior commissure and the central right-left commissure. These results indicate that the severity and location of aortic valve calcifications on chest CT are associated with an increased pressure gradient across the aortic valve.
本研究旨在将老年人胸部CT偶然发现的主动脉瓣钙化的严重程度和位置，与瓣膜上的压力阶差相关联。
回顾性纳入115名60岁及以上、胸部CT（重建层厚5mm，未使用静脉造影剂）显示主动脉瓣钙化、且在CT检查后3个月内还接受了经胸超声心动图检查的受试者。计算主动脉瓣钙化评分（阿加斯顿评分和容积评分）和主观钙化模式评分（基于9分制），并将其与超声心动图压力阶差相关联。
30例患者（26%）（中位年龄81岁）在超声心动图检查时显示主动脉瓣压力阶差增加。85名受试者（74%），包括30名年龄匹配但随机选择的对照受试者，未显示压力阶差增加。30例压力阶差增加的受试者的主动脉瓣钙化严重程度高于对照受试者（p<0.0001）。主动脉瓣平均和峰值压力阶差增加与主动脉瓣钙化主观评分相关（r分别为0.69和0.65；p<0.0001），与阿加斯顿评分相关（r分别为0.76和0.70；p<0.0001），与容积评分相关（r分别为0.78和0.73；p<0.0001）。就特定瓣叶连合而言,与平均和峰值压力阶差相关性最大的是外周左后瓣叶连合钙化（r分别为0.71和0.65；p<0.0001）和中央左右瓣叶连合钙化（r分别为0.69和0.66；p<0.0001）。
胸部CT上主动脉瓣钙化的严重程度，无论主观还是客观评估，均与主动脉瓣压力阶差增加相关，尤其是外周左后瓣叶连合和中央左右瓣叶连合的钙化。这些结果表明，胸部CT上主动脉瓣钙化的严重程度和位置与主动脉瓣压力阶差增加有关。
