Computed Tomography Aortic Valve Calcium Scoring in Patients With Bicuspid Aortic Valve Stenosis
Mylène Shen, Jin Kyung Oh, Ezéquiel Guzzetti, Gurpreet K. Singh, Tania Pawade, Lionel Tastet, Marie‐Annick Clavel, Victoria Delgado, Jeroen J. Bax, Marc R. Dweck, Amr E. Abbas, Ramy Mando, Mariano Falconi, Diego Pérez de Arenaza, Kian Keong Poh, William Kong, Edgar Tay, Gregg S. Pressman, Daniel Brito, Jae Kwan Song, Philippe Pîbarot
Abstract
Background: Sex-specific thresholds of computed tomography (CT)-derived aortic valve calcification (AVC) or AVC density (AVCd) to identify severe aortic stenosis (AS) have been established in populations that consisted mainly of Caucasians with a tricuspid aortic valve. The objective of this study was to evaluate the accuracy (i.e., sensitivity and specificity) of previously established thresholds to identify severe AS in patients with bicuspid aortic valve (BAV) and according to ethnicity: Caucasian vs. Asian. Methods: We built a multicenter registry of echocardiographic and CT data collected in BAV patients with at least mild AS and preserved left ventricular ejection fraction from 7 different centers. Anatomic severity of AS obtained by CT-derived AVC and AVCd was compared to hemodynamic severity of AS obtained by echocardiography. Results: (Se/Spe = 86/80%) for AVCd. Conclusions: The optimal thresholds to identify hemodynamically severe AS in BAV patients are similar in Caucasians but appear to be higher in Asian men, compared with thresholds previously reported in tricuspid aortic valve patients. Nonetheless, the thresholds currently proposed in the guidelines have good accuracy and can be applied in BAV patients to confirm AS severity.