Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan.
Department of Laboratory Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan.
Eur Radiol. 2023 Feb;33(2):1243-1253. doi: 10.1007/s00330-022-09114-6. Epub 2022 Sep 6.
This study evaluated the association between aortic valve calcification (AVC) and aortic stenosis (AS) by scoring the AVC to determine the threshold scores for significant AS on non-electrocardiographic (ECG)-gated computed tomography (CT).
We retrospectively analyzed the AVC scores of 5385 patients on non-contrast non-ECG-gated CT, who underwent transthoracic echocardiography (TTE) from March 1, 2013, to December 26, 2019, at our institution. Multivariable logistic regression models were used to identify potential risk factors for significant AS. The thresholds for significant AS were computed using receiver operator characteristic (ROC) curves, based on the AVC scores after propensity score matching.
A significant association was found between AS and age (p < 0.001; odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02-1.06), female sex (p < 0.001; OR, 4.5; 95% CI, 2.75-7.36), bicuspid aortic valve (p < 0.001; OR, 23.2; 95% CI, 7.35-72.9), and AVC score (AVC score/100) (p < 0.001; OR, 1.82; 95% CI, 1.71-1.95). All sex-specific AVC thresholds for significant AS (moderate and over AS severity, moderate and over AS severity without discordance, discordant severe AS, and concordant severe AS) showed high sensitivity and specificity (AUC, 0.939-0.968; sensitivity, 84.6-96%; specificity, 84.2-97.1%).
We determined the optimal AVC threshold scores for significant AS, which may aid in diagnosing significant asymptomatic AS on incidental detection of AVC through non-ECG-gated CT for non-cardiac indications.
• Increased frequency of non-electrocardiographic (ECG)-gated computed tomography (CT) for non-cardiac indications has led to the increased incidental identification of aortic valve calcification (AVC). • It is important to identify patients with significant aortic stenosis (AS) who require additional echocardiographic assessment on incidental detection of AVC via non-ECG-gated CT. • We determined the AVC thresholds with high sensitivity and specificity to identify significant AS on non-ECG-gated CT, which could lead to early diagnosis of asymptomatic significant AS and improved prognosis.
本研究通过对主动脉瓣钙化（AVC）评分来评估主动脉瓣狭窄（AS）与 AVC 的相关性，以确定非心电图门控（ECG）计算机断层扫描（CT）诊断重度 AS 的临界评分。
我们回顾性分析了 2013 年 3 月 1 日至 2019 年 12 月 26 日期间在我院行非对比非 ECG 门控 CT 的 5385 例患者的 AVC 评分。使用多变量逻辑回归模型确定重度 AS 的潜在危险因素。根据 AVC 评分和倾向评分匹配后的受试者工作特征（ROC）曲线计算重度 AS 的临界值。
AS 与年龄呈显著相关（p<0.001；优势比[OR]，1.04；95%置信区间[CI]，1.02-1.06）、女性（p<0.001；OR，4.5；95%CI，2.75-7.36）、二叶式主动脉瓣（p<0.001；OR，23.2；95%CI，7.35-72.9）和 AVC 评分（AVC 评分/100）（p<0.001；OR，1.82；95%CI，1.71-1.95）。所有性别特异性重度 AS 的 AVC 临界值（中度和重度以上 AS、中度和重度以上 AS 无差异、差异重度 AS 和一致重度 AS）均显示出较高的灵敏度和特异性（AUC，0.939-0.968；灵敏度，84.6-96%；特异性，84.2-97.1%）。
我们确定了重度 AS 的最佳 AVC 临界评分，这可能有助于通过非心电图门控 CT 诊断非心脏指征时意外发现的无症状重度 AS。
• 非心电图门控（ECG）计算机断层扫描（CT）用于非心脏指征的频率增加导致意外发现主动脉瓣钙化（AVC）的频率增加。• 重要的是要识别出在非心电图门控 CT 意外发现 AVC 时，需要进一步进行超声心动图评估的重度主动脉瓣狭窄（AS）患者。• 我们确定了具有高灵敏度和特异性的 AVC 临界值，以在非心电图门控 CT 上识别重度 AS，这可能导致无症状重度 AS 的早期诊断和改善预后。
