title: Prognostic value of multi-detector computed tomography in asymptomatic aortic valve stenosis.
abstract: BACKGROUND
  Multi-Detector Computed Tomography (MDCT) is a high-resolution imaging technique with potential additive value in the evaluation of patients with aortic valve stenosis (AS). We aimed to assess the prognostic value of MDCT in asymptomatic patients with AS compared to conventional transthoracic echocardiography (TTE).
  
  
  METHODS
  116 patients with asymptomatic AS (Vmax>2.5m/s assessed by clinical screening TTE, LVEF>50%) were examined with TTE (Vivid e9) and MDCT (Aquilion 320) on the same day. The treating physician was blinded for research protocol defined imaging results. Outcome was defined as indication for aortic valve replacement (AVR) determined by the treating physician or sudden cardiac death.
  
  
  RESULTS
  The mean age was 72 (8) years, 27% were women, mean AVA by TTE was 1.01 (0.30) cm(2). Median follow up time was 27 (IQR 19-44) months. Forty seven patients (41%) developed indication for AVR. No patients suffered a sudden cardiac death. AVA and aortic valve calcification were significant univariable predictors of AVR when measured by both TTE and MDCT, whereas left ventricular mass was only significant measured by MDCT. Significant coronary artery disease by MDCT tended to predict future indication for AVR, but this did not reach statistical significance (HR: 1.79 (95% CI 0.96-3.44), p=0.08).
  
  
  CONCLUSIONS
  MDCT derived AVA can be of use as an alternative to TTE derived AVA in patients with asymptomatic AS to predict future clinical indication for AVR.
authors.affiliation: Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark. Electronic address: linnea@dadlnet.dk.
authors.forename: Linnea Hornbech
authors.initials: LH
authors.lastname: Larsen
authors.affiliation: Departments of Radiology and Cardiology, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Klaus Fuglsang
authors.initials: KF
authors.lastname: Kofoed
authors.affiliation: Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark.
authors.forename: Helle Gervig
authors.initials: HG
authors.lastname: Carstensen
authors.affiliation: Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Dalsgaard
authors.affiliation: Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Mads Kristian
authors.initials: MK
authors.lastname: Ersbøll
authors.affiliation: Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.affiliation: Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Hassager
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000209:etiology; D058070:Asymptomatic Diseases; D002114:Calcinosis / Q000150:complications / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors
keywords: Aortic valve area; Aortic valve calcification; Aortic valve stenosis; Coronary artery disease; Left ventricular mass; Multi-detector computed tomography