From the Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (T.P., W.S.A.J., T.R.G.C., D.E.N., M.R.D.); Institut Universitaire de Cardiology et de Pneumologie de Québec (Quebec Heart and Lung Institute), Laval University, Canada (M.-A.C., L.T., P.P.); Department of Cardiology, Centre Hospitalier Universitaire d'Amiens, Picardie, France (C.T., M.G.); Centre Cardiologique du Nord, Saint-Denis, France (J.D., L.M.); Department of Cardiology, Bichat Hospital, Paris, France (T.M., V.N., D.M.Z.); Department of Radiology, Centre Hospitalier Universitaire d/Amiens, Picardie, France (C.R.); Division of Cardiothoracic Imaging, Department of Radiology (J.W.S., J.M.L.) and Division of Cardiology, Department of Medicine (J.L.C.), University of Pittsburgh Medical Center, PA; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (L.G.G., H.C.C., A.E.); and Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (I.N., B.P., R.R.).
Circ Cardiovasc Imaging. 2018 Mar;11(3):e007146. doi: 10.1161/CIRCIMAGING.117.007146.
BACKGROUND: Computed tomography aortic valve calcium scoring (CT-AVC) holds promise for the assessment of patients with aortic stenosis (AS). We sought to establish the clinical utility of CT-AVC in an international multicenter cohort of patients. METHODS AND RESULTS: Patients with AS who underwent ECG-gated CT-AVC within 3 months of echocardiography were entered into an international, multicenter, observational registry. Optimal CT-AVC thresholds for diagnosing severe AS were determined in patients with concordant echocardiographic assessments, before being used to arbitrate disease severity in those with discordant measurements. In patients with long-term follow-up, we assessed whether CT-AVC thresholds predicted aortic valve replacement and death. In 918 patients from 8 centers (age, 77±10 years; 60% men; peak velocity, 3.88±0.90 m/s), 708 (77%) patients had concordant echocardiographic assessments, in whom CT-AVC provided excellent discrimination for severe AS (C statistic: women 0.92, men 0.89). Our optimal sex-specific CT-AVC thresholds (women 1377 Agatston unit and men 2062 Agatston unit) were nearly identical to those previously reported (women 1274 Agatston unit and men 2065 Agatston unit). Clinical outcomes were available in 215 patients (follow-up 1029 [126-2251] days). Sex-specific CT-AVC thresholds independently predicted aortic valve replacement and death (hazard ratio, 3.90 [95% confidence interval, 2.19-6.78]; <0.001) after adjustment for age, sex, peak velocity, and aortic valve area. Among 210 (23%) patients with discordant echocardiographic assessments, there was considerable heterogeneity in CT-AVC scores, which again were an independent predictor of clinical outcomes (hazard ratio, 3.67 [95% confidence interval, 1.39-9.73]; =0.010). CONCLUSIONS: Sex-specific CT-AVC thresholds accurately identify severe AS and provide powerful prognostic information. These findings support their integration into routine clinical practice. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifiers: NCT01358513, NCT02132026, NCT00338676, NCT00647088, NCT01679431.
背景：计算机断层扫描主动脉瓣钙评分（CT-AVC）有望用于评估主动脉瓣狭窄（AS）患者。我们旨在建立 CT-AVC 在国际多中心 AS 患者队列中的临床应用。
方法和结果：在超声心动图检查后 3 个月内接受心电图门控 CT-AVC 的 AS 患者被纳入国际多中心观察性登记处。在具有一致超声心动图评估的患者中确定了用于诊断重度 AS 的最佳 CT-AVC 阈值，然后在具有不一致测量值的患者中用于仲裁疾病严重程度。在具有长期随访的患者中，我们评估了 CT-AVC 阈值是否预测主动脉瓣置换和死亡。在来自 8 个中心的 918 例患者（年龄 77±10 岁；60%为男性；峰值速度 3.88±0.90 m/s）中，708 例（77%）患者具有一致的超声心动图评估，其中 CT-AVC 对重度 AS 具有出色的鉴别能力（C 统计量：女性为 0.92，男性为 0.89）。我们的最佳性别特异性 CT-AVC 阈值（女性 1377 个 Agatston 单位，男性 2062 个 Agatston 单位）与之前报道的结果几乎相同（女性 1274 个 Agatston 单位，男性 2065 个 Agatston 单位）。在 215 例患者中获得了临床结果（随访 1029[126-2251]天）。性别特异性 CT-AVC 阈值在调整年龄、性别、峰值速度和主动脉瓣面积后，可独立预测主动脉瓣置换和死亡（风险比，3.90[95%置信区间，2.19-6.78]；<0.001）。在 210 例（23%）超声心动图评估不一致的患者中，CT-AVC 评分存在明显的异质性，这再次是临床结局的独立预测因素（风险比，3.67[95%置信区间，1.39-9.73]；=0.010）。
结论：性别特异性 CT-AVC 阈值可准确识别重度 AS 并提供有力的预后信息。这些发现支持将其纳入常规临床实践。
临床试验注册：网址：http://www.clinicaltrials.gov。唯一标识符：NCT01358513、NCT02132026、NCT00338676、NCT00647088、NCT01679431。
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