Application of a Novel Two-Dimensional Echocardiographic Calcium Quantification Method to Assess All Severities of Aortic Stenosis

• Published in: Journal of the American Society of Echocardiography Vol. 36; no. 1; pp. 69 - 76
• Main Authors: Desai, Kevin, Slostad, Brody, Twing, Aamir, Krishna, Hema, Frazin, Leon, Kansal, Mayank
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2023
• Subjects: Adult echocardiography; Aortic stenosis; Aortic Valve - diagnostic imaging; Aortic Valve Stenosis - diagnostic imaging; Calcium; Echocardiography; Humans; Multidetector Computed Tomography - methods; Retrospective Studies; Severity of Illness Index; Valvular heart disease; Aortic stenosis; EF; TTE; DI; AVA; LVOT; MDCT; AV MnG; AVC; Adult echocardiography; AUC; Valvular heart disease; 2D; AS; AV; AV Vmax
• ISSN: 0894-7317; 1097-6795
• DOI: 10.1016/j.echo.2022.10.023

Aortic valve (AV) calcification (AVC) is a strong predictor of aortic stenosis (AS) severity. The two-dimensional AVC (2D-AVC) ratio, a gain-independent ratio composed of the average pixel density of the AV and the aortic annulus, has previously shown strong correlations with two-dimensional (2D) echocardiographic hemodynamic parameters for severe AS and AVC by cardiac computed tomography. We hypothesize that the 2D-AVC ratio correlates with hemodynamic parameters in all severities of AS.
A total of 285 patients with a normal AV (n = 49), aortic sclerosis (n = 75), or mild (n = 38), moderate (n = 72), or severe (n = 51) AS undergoing 2D echocardiography were retrospectively evaluated, and the 2D-AVC ratios were correlated to mean AV gradient, peak AV velocity, AV area, and dimensionless index. The 2D-AVC ratios of various AS severities were compared against each other via area under the curve (AUC) analysis.
The 2D-AVC ratio is strongly correlated with mean AV gradient (r = 0.79, P < .0001) and peak AV velocity (r = 0.78, P < .0001). There was moderate correlation with the AV area (r = –0.58, P < .0001) and dimensionless index (r = –0.67, P < .0001) across all AS severities. The 2D-AVC ratio also distinguished nonmoderate AS (mild AS + normal AV) from moderate or greater (moderate + severe) AS (AUC = 0.93) and moderate versus severe AS (AUC = 0.88).
The 2D-AVC ratio exhibits moderate to strong correlation with 2D echocardiographic hemodynamic parameters across all severities of AS.
•The 2D-AVC ratio is a novel marker of echocardiographic valvular calcium burden.•The 2D-AVC ratio correlates with echocardiographic hemodynamic parameters in AS.•The 2D-AVC ratio can accurately differentiate between severe and nonsevere AS.