Aortic valve calcification as an incidental finding at CT of the elderly: Severity and location as predictors of aortic stenosis
Aortic valve calcification as an incidental finding at CT of the elderly: Severity and location as predictors of aortic stenosis
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DOI：
10.2214/ajr.04.1366
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发表时间：
2006-02-01
影响因子：
5
通讯作者：
Austin, JHM
中科院分区：
文献类型：
--
作者：
Liu, F;Coursey, CA;Austin, JHM
OBJECTIVE.本研究的目的是将主动脉瓣钙化的严重程度和位置（作为老年人胸部CT的偶然发现）与跨瓣压差相关。回顾性确定了115例年龄≥ 60岁、胸部CT显示主动脉瓣钙化（5 mm重建切片宽度，无IV造影剂）且在CT检查后3个月内接受过经胸超声心动图检查的受试者。计算主动脉瓣钙化评分（Agatston和体积）和主观钙化模式评分（基于9分制），并与超声心动图梯度相关。确定了30例患者（26%）（中位年龄81岁），超声心动图显示主动脉瓣跨瓣压差增加。85名受试者（74%），包括30名年龄匹配但随机选择的对照受试者，未显示压差增加。30例压差增加的受试者的主动脉瓣钙化严重程度高于对照受试者（p < 0.0001）。主动脉瓣平均和峰值压差的增加与主动脉瓣钙化的主观评分相关（r分别为0.69和0.65; p < 0.0001），Agatston评分（分别为r = 0.76和0.70; p < 0.0001），以及体积评分（分别为r = 0.78和0.73; p < 0.0001）。就特定连合而言，与平均和峰值梯度相关性最大的是外周左后连合钙化（r分别为0.71和0.65; p < 0.0001）和中央右左连合钙化（r分别为0.69和0.66; p < 0.0001）。主观或客观评估的胸部CT上主动脉瓣钙化的严重程度与主动脉瓣跨瓣压差增加相关，特别是外周左后连合和中央右左连合的钙化。这些结果表明，胸部CT上主动脉瓣钙化的严重程度和位置与主动脉瓣跨瓣压差增加相关。
OBJECTIVE. The purpose of this study was to correlate the severity and location of aortic valve calcifications, as an incidental finding at chest CT of elderly persons, with pressure gradients across the valveMATERIALS AND METHODS. One hundred fifteen subjects who were 60 years old or older and who showed aortic valve calcification on chest CT (5-mm reconstructed section width, no IV contrast material) and who had also undergone transthoracic echocardiography within 3 months of the CT examination were identified retrospectively. Aortic valve calcification scores (Agatston and volumetric) and subjective calcification pattern scores (based on a 9-point scale) were calculated and correlated with echocardiographic gradients.RESULTS. Thirty patients (26%) (median age, 81 years) were identified who showed an increased pressure gradient across the aortic valve at echocardiography. Eighty-five subjects (74%), including 30 age-matched but otherwise randomly selected control subjects, showed no increase in pressure gradient. The severity of aortic valve calcification was greater for the 30 subjects with an increased gradient than for the control subjects (p < 0.0001). Increased mean and peak gradients across the aortic valve correlated with the subjective scores for aortic valve calcification (r = 0.69 and 0.65, respectively; p < 0.0001), with Agatston scores (r = 0.76 and 0.70, respectively; p < 0.0001), and with volumetric scores (r = 0.78 and 0.73, respectively; p < 0.0001). In terms of specific commissures, the greatest correlation with mean and peak gradients was for peripheral left-posterior commissural calcification (r = 0.71 and 0.65, respectively; p < 0.0001) and central right-left commissural calcification (r = 0.69 and 0.66, respectively; p < 0.0001).CONCLUSION. The severity of aortic valve calcifications on chest CT, as assessed either subjectively or objectively, correlated with increased pressure gradients across the aortic valve, particularly for calcification of the peripheral left-posterior commissure and the central right-left commissure. These results indicate that the severity and location of aortic valve calcifications on chest CT are associated with an increased pressure gradient across the aortic valve.