title: Comparison of the aortic valve calcium content in the bicuspid and tricuspid stenotic aortic valve using non-enhanced 64-detector-row-computed tomography with prospective ECG-triggering.
abstract: OBJECTIVE
  The aim of our study was to compare the calcium content measured by non-enhanced multidetector-row-computed tomography (MDCT) between patients with significant stenosis of bicuspid (BAV) and tricuspid aortic valve (TAV). Another aim of our study was to assess the accuracy of the non-enhanced MDCT to distinguish BAV and TAV based on the calcified plaque morphology, and to compare the results with the transesophageal echocardiography.
  
  
  METHODS
  A retrospective analysis of prospectively collected data was performed. Consecutive patients with symptomatic aortic stenosis (AS) admitted to hospital for evaluation before valve surgery underwent clinical evaluation, transthoracic and transesophageal echocardiography, and non-enhanced examination with the 64-detector-row CT using prospective ECG triggering with data acquisition in diastolic phase. The data acquisition started at 55% of the R-R interval. The patients were examined in the supine position in mild inspiration. Data were evaluated using dedicated software for calcium scoring, the volume of calcifications and calcium content were obtained.
  
  
  RESULTS
  Thirty-seven patients (20 males, age 48-83 years) were enrolled. BAV was present in 13 patients, TAV in 24 patients. The calcium score in patients with severe AS (mean gradient >50 mmHg) was higher than in those with moderate AS (1123+/-616 mg versus 634+/-475, P=0.011). Significant correlation between the calcium scores and transaortic gradients was found (r=0.53, P=0.002). The patients with BAV did not differ significantly from those with TAV in the AS severity (58+/-13 versus 53+/-20 mmHg), nor in the valve calcium score (1168+/-717 versus 795+/-530 mg, P=0.093). The overall sensitivity to detect BAV in patients with calcified severe AS was 0.923 (12/13) and specificity 0.958 (23/24). The overall accuracy was 0.945 (35/37).
  
  
  CONCLUSIONS
  We observed higher calcium score in patients with severe AS than with moderate AS. However, no difference in aortic valve calcium score between BAV and TAV was found. Thus, in our sample, the aortic valve calcium score correlated with AS severity, not with aortic valve morphology. Based on the calcified plaque space relationship, the aortic BAV and TAV could be distinguished in most cases.
authors.affiliation: Department of Radiology, Charles University Hospital Plzen, Alej Svobody 80, CZ-306 40 Plzen, Czech Republic. ferda@fnplzen.cz
authors.forename: Jirí
authors.initials: J
authors.lastname: Ferda
authors.forename: Katerina
authors.initials: K
authors.lastname: Linhartová
authors.forename: Boris
authors.initials: B
authors.lastname: Kreuzberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging*; D001027:Aortography / Q000379:methods*; D002114:Calcinosis / Q000000981:diagnostic imaging*; D055424:Cardiac-Gated Imaging Techniques / Q000379:methods*; D003287:Contrast Media; D004562:Electrocardiography / Q000379:methods; D006801:Humans; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014261:Tricuspid Valve / Q000000981:diagnostic imaging*
chemical_list: D003287:Contrast Media