Department of Cardiology, University of Illinois at Chicago, Chicago, Illinois 60612.
Department of Medicine, University of Illinois at Chicago, Chicago, Illinois 60612.
Am J Cardiol. 2021 Oct 1;156:108-113. doi: 10.1016/j.amjcard.2021.07.002. Epub 2021 Aug 1.
Aortic valve calcium (AVC) is a strong predictor of aortic stenosis (AS) severity and is typically calculated by multidetector computed tomography (MDCT). We propose a novel method using pixel density quantification software to objectively quantify AVC by two-dimensional (2D) transthoracic echocardiography (TTE) and distinguish severe from non-severe AS. A total of 90 patients (mean age 76 ± 10 years, 75% male, mean AV gradient 32 ± 11 mmHg, peak AV velocity 3.6 ± 0.6 m/s, AV area (AVA) 1.0 ± 0.3 cm, dimensionless index (DI) 0.27 ± 0.08) with suspected severe aortic stenosis undergoing 2D echocardiography were retrospectively evaluated. Parasternal short axis aortic valve views were used to calculate a gain-independent ratio between the average pixel density of the entire aortic valve in short axis at end diastole and the average pixel density of the aortic annulus in short axis (2D-AVC ratio). The 2D-AVC ratio was compared to echocardiographic hemodynamic parameters associated with AS, MDCT AVC quantification, and expert reader interpretation of AS severity based on echocardiographic AVC interpretation. The 2D-AVC ratio exhibited strong correlations with mean AV gradient (r = 0.72, p < 0.001), peak AV velocity (r = 0.74, p < 0.001), AVC quantified by MDCT (r = 0.71, p <0.001) and excellent accuracy in distinguishing severe from non-severe AS (area under the curve = 0.93). Conversely, expert reader interpretation of AS severity based on echocardiographic AVC was not significantly related to AV mean gradient (t = 0.23, p = 0.64), AVA (t = 2.94, p = 0.11), peak velocity (t = 0.59, p = 0.46), or DI (t = 0.02, p = 0.89). In conclusion, these data suggest that the 2D-AVC ratio may be a complementary method for AS severity adjudication that is readily quantifiable at time of TTE.
主动脉瓣钙（AVC）是主动脉瓣狭窄（AS）严重程度的有力预测因子，通常通过多排螺旋 CT（MDCT）计算。我们提出了一种新的方法，使用像素密度量化软件通过二维（2D）经胸超声心动图（TTE）客观量化 AVC，并区分严重和非严重的 AS。共回顾性评估了 90 名疑似严重主动脉瓣狭窄患者（平均年龄 76 ± 10 岁，75%为男性，平均 AV 梯度 32 ± 11mmHg，峰值 AV 速度 3.6 ± 0.6m/s，AV 面积（AVA）1.0 ± 0.3cm，无纲量指数（DI）0.27 ± 0.08），并进行了 2D 超声心动图检查。胸骨旁短轴主动脉瓣切面用于计算舒张末期短轴主动脉瓣整个平均像素密度与短轴主动脉瓣环平均像素密度的比值（2D-AVC 比值）。将 2D-AVC 比值与与 AS 相关的超声心动图血流动力学参数、MDCT 量化的 AVC 和基于超声心动图 AVC 解释的专家读者对 AS 严重程度的解释进行比较。2D-AVC 比值与平均 AV 梯度（r = 0.72，p <0.001）、峰值 AV 速度（r = 0.74，p <0.001）、MDCT 量化的 AVC（r = 0.71，p <0.001）呈强相关性，并具有良好的区分严重和非严重 AS 的准确性（曲线下面积 = 0.93）。相反，基于超声心动图 AVC 的专家读者对 AS 严重程度的解释与 AV 平均梯度（t = 0.23，p = 0.64）、AVA（t = 2.94，p = 0.11）、峰值速度（t = 0.59，p = 0.46）或 DI（t = 0.02，p = 0.89）无显著相关性。总之，这些数据表明，2D-AVC 比值可能是一种补充的 AS 严重程度判断方法，在 TTE 时易于量化。
