Computed tomography aortic valve calcium scoring for the assessment of aortic stenosis progression.

Abstract

CT quantification of aortic valve calcification (CT-AVC) is useful in the assessment of aortic stenosis severity. Our objective was to assess its ability to track aortic stenosis progression compared with echocardiography. Subjects were recruited in two cohorts: (1) a <i>reproducibility cohort</i> where patients underwent repeat CT-AVC or echocardiography within 4 weeks and (2) a <i>disease progression cohort</i> where patients underwent annual CT-AVC and/or echocardiography. Cohen's d-statistic (<i>d</i>) was computed from the ratio of annualised progression and measurement repeatability and used to estimate group sizes required to detect annualised changes in CT-AVC and echocardiography. A total of 33 (age 71±8) and 81 participants (age 72±8) were recruited to the reproducibility and progression cohorts, respectively. Ten CT scans (16%) were excluded from the progression cohort due to non-diagnostic image quality. Scan-rescan reproducibility was excellent for CT-AVC (limits of agreement -12% to 10 %, intraclass correlation (ICC) 0.99), peak velocity (-7% to +17%; ICC 0.92) mean gradient (-25% to 27%, ICC 0.96) and dimensionless index (-11% to +15%; ICC 0.98). Repeat measurements of aortic valve area (AVA) were less reliable (-44% to +28%, ICC 0.85).CT-AVC progressed by 152 (65-375) AU/year. For echocardiography, the median annual change in peak velocity was 0.1 (0.0-0.3) m/s/year, mean gradient 2 (0-4) mm Hg/year and AVA -0.1 (-0.2-0.0) cm²/year. Cohen's d-statistic was more than double for CT-AVC (<i>d</i>=3.12) than each echocardiographic measure (peak velocity <i>d</i>=0.71 ; mean gradient <i>d</i>=0.66; AVA <i>d</i>=0.59, dimensionless index <i>d</i>=1.41). CT-AVC is reproducible and demonstrates larger increases over time normalised to measurement repeatability compared with echocardiographic measures.