The Heart Valve Society

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Routine Transthoracic Echocardiogram Alone is Unreliable in Assessing Aortic Valve Calcification
Alicia M. Bonanno, Eric Zimmerman, Giye Choe, Hayden Leeds, Justin J. Watson, Awais Ashfaq, Firas Zahr, Cristina Fuss, Jaishankar Raman.
Oregon Health and Science University, Portland, OR, USA.

OBJECTIVE:
To evaluate whether assessment of calcification of aortic valves in standard transthoracic echocardiograms(TTE) correlates with actual calcium burden represented by aortic valve Agatston score. METHODS:
A retrospective review was performed in 150 patients who underwent both TTE and non-contrast computed tomography (CT) of the aortic valve as work up for a multidisciplinary cardiac valve disease from 2016-2017. The TTE was read by board certified echocardiologists. The aortic valve Agatston score was calculated on the CT scans, using Philips Intellispace Portal Radiology DICOM image processing application software. Data collected were TTE description of the aortic valve including severity of aortic stenosis, calcification, leaflet thickening and restriction, as well as, aortic valve Agatston score, study quality, patient body surface area and BMI, and presence of Mitral Annular Calcification(MAC). RESULTS:
The study population was 62% male with average age of 78 years, BMI of 31, and BSA of 1.98 . The median CT Aortic Calcium Score was 2183 (IQR: 1590-3079). The majority of patients in the study sample had severe aortic stenosis (74.7% or 112/150). There was no association between the description of calcification on the aortic valve made on TTE and the Agatston score (p = 0.93). In multivariate analysis, when accounting for body surface area and BMI, there were no significant associations with Agatston score and TTE study quality, description of thickening and restriction, or presence of MAC (see table A). CONCLUSIONS:
TTE descriptions of calcium burden correlated poorly with CT derived Agatston scores. Since increasing calcium burden correlates with worse outcomes in AVR, an echocardiographic assessment alone should not be relied on for assessing calcium burden in the aortic valve during patient evaluation for AVR. Assessment of Agatston scores on CT may improve overall outcomes when used for preoperative planning prior to valve intervention.


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