Journal of cardiovascular computed tomography · 2023
Multimodality assessment of high- vs. low-gradient aortic stenosis using echocardiography and cardiac CT.
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Zeb Irfan, Uqaily Raafay, Gonuguntla Karthik, Ludhwani Dipesh, Abdelhaleem Ahmed, Leipsic Jonathon, Hahn Rebecca T, Pibarot Philippe, Sankaramangalam Kesavan, Kuzhandai Dhivya, Sattar Yasar, Raina Sameer, Sudarshan Balla, Kawsara Mohammad, Hamirani Yasmin, Daggubati Ramesh
Аннотация
BACKGROUND: Aortic valve area (AVA) using CT-LVOT area (AVACT-LVOT) <1.2 cm2 has been shown comparable to echocardiography AVA of <1.0 cm2 for severe aortic stenosis (AS). Current study evaluates how AS diagnosis will be affected when we substitute CT-LVOT with echo derived LVOT.
METHODS: We retrospectively studied 367 patients who underwent cardiac CTA and echocardiogram for assessment of high- and low-gradient AS (HG-AS and LG-AS). AVACT-LVOT was derived from CT-LVOT area and echo doppler data. Three AVACT-LVOT categories were created (<1.0, 1.0-1.2 and > 1.2 cm2). Outcomes were defined as composite of all-cause mortality and/or valve intervention.
RESULTS: Median echocardiographic profiles were consistent with severe AS across three AVACT-LVOT categories for HG-AS. HG-AS patients with AVACT-LVOT >1.2 cm2 had larger median CT-LVOT area (5.06 cm2) and AVC (2917AU). Among LG-AS with AVACT-LVOT ≤1.2 cm2, 57% met echo criteria for low-flow LG-AS and 63% met criteria for severe AS using aortic valve calcium (AVC). Additionally, 45% with AVACT-LVOT >1.2 cm2 had larger median CT-LVOT area (5.43 cm2) and AVC (2389AU). Patients with AVACT-LVOT >1.2 cm2 and high AVC had large body surface area and were mostly characterized as severe with indexed AVA and AVC. Stroke volume index using CT-LVOT reclassified 70% of low-flow, LG-AS as normal flow, LG-AS. Composite outcomes were higher among patients with AVACT-LVOT ≤1.2 cm2 (p < 0.01), however, with no superior net reclassification improvement compared to AVAecho <1.0 cm2.
CONCLUSION: AVACT-LVOT ≤1.2 cm2 is a reasonable CT criterion for severe AS. Large LVOT with elevated AVC identified a severe AS phenotype despite an AVACT-LVOT >1.2 cm2, best characterized by indexed AVA and AVC.
METHODS: We retrospectively studied 367 patients who underwent cardiac CTA and echocardiogram for assessment of high- and low-gradient AS (HG-AS and LG-AS). AVACT-LVOT was derived from CT-LVOT area and echo doppler data. Three AVACT-LVOT categories were created (<1.0, 1.0-1.2 and > 1.2 cm2). Outcomes were defined as composite of all-cause mortality and/or valve intervention.
RESULTS: Median echocardiographic profiles were consistent with severe AS across three AVACT-LVOT categories for HG-AS. HG-AS patients with AVACT-LVOT >1.2 cm2 had larger median CT-LVOT area (5.06 cm2) and AVC (2917AU). Among LG-AS with AVACT-LVOT ≤1.2 cm2, 57% met echo criteria for low-flow LG-AS and 63% met criteria for severe AS using aortic valve calcium (AVC). Additionally, 45% with AVACT-LVOT >1.2 cm2 had larger median CT-LVOT area (5.43 cm2) and AVC (2389AU). Patients with AVACT-LVOT >1.2 cm2 and high AVC had large body surface area and were mostly characterized as severe with indexed AVA and AVC. Stroke volume index using CT-LVOT reclassified 70% of low-flow, LG-AS as normal flow, LG-AS. Composite outcomes were higher among patients with AVACT-LVOT ≤1.2 cm2 (p < 0.01), however, with no superior net reclassification improvement compared to AVAecho <1.0 cm2.
CONCLUSION: AVACT-LVOT ≤1.2 cm2 is a reasonable CT criterion for severe AS. Large LVOT with elevated AVC identified a severe AS phenotype despite an AVACT-LVOT >1.2 cm2, best characterized by indexed AVA and AVC.