Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
Int J Cardiol. 2013 Oct 15;168(6):5205-11. doi: 10.1016/j.ijcard.2013.07.235. Epub 2013 Aug 2.
Cardiac computed tomography angiography (CCTA) provides the simultaneous evaluation of the aortic valve, myocardium, and coronary arteries. In particular, aortic valve calcium score (AVCS) can be accurately measured on the same scanning sequence used to measure coronary artery calcification, with no additional cost or radiation exposure. We sought to evaluate the prognostic value of CCTA measures, including AVCS, in asymptomatic aortic stenosis (AS).
Sixty-four initially asymptomatic patients with AS with a normal ejection fraction were prospectively enrolled and followed for median 29 (IQR=18-50) months. During follow-up, 27 (42%) patients experienced cardiac events, including five cardiac deaths, eleven aortic valve replacements. Multivariate Cox proportional hazards analysis identified three CCTA measures as significant predictors of cardiac events: aortic valve area (per 0.1cm(2) decrease; hazard ratio [HR]: 1.19, 95% confidence interval [CI]: 1.05-1.34); multi-vessel obstructive coronary artery disease (HR: 2.84, 95% CI: 1.10-7.32); and AVCS (per 100; HR: 1.09, 95% CI: 1.04-1.15). Kaplan-Meier analysis showed that patients with AVCS greater than or equal to the median value of 723 had significantly worse outcomes than those with AVCS less than 723 (p<0.0001). The C-statistic value for cardiac events substantially increased when these CCTA measures were added to clinical characteristics plus echocardiographic peak transaortic velocity (0.913 vs. 0.702, p<0.001).
In patients with asymptomatic AS, CCTA measures of valve area, coronary stenosis, and calcification severity provide independent and incremental prognostic value after accounting for the echocardiographic severity of stenosis.
心脏计算机断层扫描血管造影（CCTA）可同时评估主动脉瓣、心肌和冠状动脉。特别是，主动脉瓣钙评分（AVCS）可在用于测量冠状动脉钙化的相同扫描序列上准确测量，且无额外费用或辐射暴露。我们旨在评估 CCTA 测量值（包括 AVCS）在无症状主动脉瓣狭窄（AS）中的预后价值。
前瞻性纳入 64 例初始无症状且射血分数正常的 AS 患者，中位随访时间为 29（IQR=18-50）个月。随访期间，27 例（42%）患者发生心脏事件，包括 5 例心脏死亡，11 例主动脉瓣置换术。多变量 Cox 比例风险分析确定了 3 项 CCTA 测量值是心脏事件的显著预测因子：主动脉瓣面积（每减少 0.1cm²；风险比[HR]：1.19，95%置信区间[CI]：1.05-1.34）；多支阻塞性冠状动脉疾病（HR：2.84，95%CI：1.10-7.32）；以及 AVCS（每增加 100；HR：1.09，95%CI：1.04-1.15）。Kaplan-Meier 分析显示，AVCS 大于或等于 723 的患者比 AVCS 小于 723 的患者结局显著更差（p<0.0001）。当将这些 CCTA 测量值添加到临床特征加超声心动图跨主动脉峰值速度后，心脏事件的 C 统计值显著增加（0.913 与 0.702，p<0.001）。
在无症状 AS 患者中，瓣膜面积、冠状动脉狭窄和钙化严重程度的 CCTA 测量值在考虑到狭窄的超声心动图严重程度后提供了独立且增量的预后价值。
