Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Cardiology, Quebec Heart and Lung Institute, Quebec, Quebec, Canada.
Heart. 2024 Mar 22;110(8):594-602. doi: 10.1136/heartjnl-2023-323281.
CT aortic valve calcium score (AVC) and density (AVC) thresholds have been recommended for aortic stenosis (AS) severity assessment in tricuspid aortic valve (TAV). We aimed to compare AVC and AVC in bicuspid aortic valve (BAV) versus TAV.
Retrospective single-centre study of patients with echocardiographic AS-severity and CT-AVC assessments within 6 months, and left ventricular ejection fraction ≥50%, all referred for clinical AS evaluation.Severe AS was defined as aortic valve area (AVA) ≤1 cm or indexed AVA ≤0.6cm/m plus mean gradient ≥40 mm Hg or peak velocity ≥4 m/s. AVC was assessed by Agatston method.
Of the 1957 patients, 328 had BAV and 1629 had TAV, age 65±11 vs 80±9 years (p<0.001), men 65% vs 56% (p=0.006), respectively. BAV morphology was associated with higher AVC and AVC independent of age, comorbidities and AS severity (p<0.001) in men only (sex and BAV interaction p<0.001). In patients with severe AS, mean AVC and AVC were higher in BAV-men than that in TAV-men (both p<0.001), but similar in BAV-women and TAV-women (both p≥0.4). Such patterns remained the same after adjustment for clinical covariates and AS severity. Best thresholds for severe AS diagnosis in BAV-men were 2916 AU by AVC and 600 AU/cm by AVC which were higher than the guideline-recommended thresholds, while thresholds in BAV-women (1036 AU and 282 AU/cm) were similar to guideline-recommended ones.
Valve calcification in AS differs according to valve morphology and sex. BAV-men with severe AS exhibit greater AVC and AVC than TAV-men. This presents a diagnostic challenge to the current guidelines, which needs confirmation in larger studies.
CT 主动脉瓣钙评分（AVC）和密度（AVC）阈值已被推荐用于三尖瓣主动脉瓣（TAV）的主动脉瓣狭窄（AS）严重程度评估。我们旨在比较二叶式主动脉瓣（BAV）与三叶式主动脉瓣（TAV）的 AVC 和 AVC。
回顾性单中心研究，纳入了在 6 个月内接受超声心动图 AS 严重程度和 CT-AVC 评估以及左心室射血分数≥50%的患者，所有患者均因临床 AS 评估而转诊。严重 AS 的定义为主动脉瓣口面积（AVA）≤1cm 或指数化 AVA≤0.6cm/m 加上平均梯度≥40mmHg 或峰值速度≥4m/s。AVC 通过 Agatston 方法评估。
在 1957 例患者中，328 例为 BAV，1629 例为 TAV，年龄分别为 65±11 岁和 80±9 岁（p<0.001），男性分别占 65%和 56%（p=0.006）。BAV 形态与男性的 AVC 和 AVC 独立于年龄、合并症和 AS 严重程度有关（均 p<0.001）（性别与 BAV 相互作用 p<0.001）。在严重 AS 患者中，BAV 男性的平均 AVC 和 AVC 均高于 TAV 男性（均 p<0.001），但 BAV 女性和 TAV 女性之间相似（均 p≥0.4）。在调整临床协变量和 AS 严重程度后，仍存在相同的模式。BAV 男性严重 AS 诊断的最佳阈值为 AVC 为 2916AU 和 AVC 为 600AU/cm，高于指南推荐的阈值，而 BAV 女性的阈值（1036AU 和 282AU/cm）与指南推荐的相似。
根据瓣膜形态和性别，AS 中的瓣膜钙化不同。严重 AS 的 BAV 男性比 TAV 男性具有更大的 AVC 和 AVC。这对当前指南提出了诊断挑战，需要在更大的研究中进行证实。
