title: Real-time imaging required for optimal echocardiographic assessment of aortic valve calcification.
abstract: BACKGROUND
  Aortic valve calcification (AVC), even without haemodynamic significance, may be prognostically import as an expression of generalized atherosclerosis, but techniques for echocardiographic assessment are essentially unexplored.
  
  
  METHODS
  Two-dimensional (2D) echocardiographic recordings (Philips IE33) of the aortic valve in short-axis and long-axis views were performed in 185 consecutive patients within 1 week before surgery for aortic stenosis (n = 109, AS), aortic regurgitation (n = 61, AR), their combination (n = 8) or dilation of the ascending aorta (n = 7). The grey scale mean (GSMn) of the aortic valve in an end-diastolic short-axis still frame was measured. The same frame was scored visually 1-5 as indicating that the aortic valve was normal, thick, or had mild, moderate or severe calcification. The visual echodensity of each leaflet was determined real time applying the same 5-grade scoring system for each leaflet, and the average for the whole valve was calculated. Finally, a similar calcification score for the whole valve based on inspection and palpation by the surgeon was noted.
  
  
  RESULTS
  Visual assessment of real-time images using the proposed scoring system showed better correlation with the surgical evaluation of the degree of valve calcification (r = 0·83, P<0·001) compared to evaluation of stop frames by visual assessment (r = 0·66, P< 0·001) or the GSMn score (r = 0·64, P< 0·001). High inter- and intra-observer correlations were observed for real-time visual score (both intraclass correlation coefficient = 0·93).
  
  
  CONCLUSIONS
  Real-time evaluation of the level of AVC is superior to using stop frames assessed either visually or by dedicated computer grey scale measurement software.
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Yousry
authors.forename: Anette
authors.initials: A
authors.lastname: Rickenlund
authors.forename: Johan
authors.initials: J
authors.lastname: Petrini
authors.forename: Tomas
authors.initials: T
authors.lastname: Gustavsson
authors.forename: Ulrica
authors.initials: U
authors.lastname: Prahl
authors.forename: Jan
authors.initials: J
authors.lastname: Liska
authors.forename: Per
authors.initials: P
authors.lastname: Eriksson
authors.forename: Anders
authors.initials: A
authors.lastname: Franco-Cereceda
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Eriksson
authors.forename: Kenneth
authors.initials: K
authors.lastname: Caidahl
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000601:surgery; D003199:Computer Systems; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D012984:Software; D014463:Ultrasonography