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Threshold for calcium volume evaluation in patients with aortic valve stenosis: correlation with Agatston score

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  • Marco Angelillis
  • Giulia Costa
  • Ole De Backer
  • Veronica Mochi
  • Andrea Christou
  • Cristina Giannini
  • Paolo Spontoni
  • Marco De Carlo
  • Lars Søndergaard
  • Mario Miccoli
  • Anna S Petronio
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BACKGROUND: The evaluation of aortic valve calcium burden is important when planning for transcatheter aortic valve implantation (TAVI). Although a robust golden standard methodology is available for calcium evaluation on noncontrast-enhanced (NCE) computed tomographic (CT) series, a standard reference for calcium assessment on contrast-enhanced CT series is currently lacking.

METHODS: Two hundred and forty-four preprocedural CT scans from patients who had received TAVI were analysed. We correlated the aortic calcium volumes obtained on CE series at three thresholds [450, 850, and 'probe + 100' Hounsfield Units (HU)] with the Agatston score obtained on NCE scans. A subgroup analysis was performed taking into account the contrast enhancement of the left ventricular outflow tract (LVOT), with a prespecified cut-off of 300 HU.

RESULTS: The overall population analysis showed higher correlation with the Agatston score using the 850 HU threshold (r = 0.45, P < 0.0001); no correlation was found with the 450 HU threshold, whilst the 'probe + 100' HU threshold showed a weaker correlation (r = 0.30, P < 0.0001). In patients with LVOT enhancement less than 300 HU, 450 HU showed the highest accuracy in calcium identification (r = 0.70, P < 0.0001), whereas in patients with LVOT enhancement of at least 300 HU, the most accurate threshold was 850 HU (r = 0.46, P < 0.0001).

CONCLUSION: The thresholds for correct calcium identification using the automatic 3Mensio software depend on the contrast enhancement of aortic and cardiac structures, which can be estimated by measuring the HU in the LVOT. In patients with LVOT HU of less than 300, the correct threshold to be set in the software is 450 HU, whereas in patients with LVOT HU of at least 300 the correct threshold is 850 HU.

Original languageEnglish
JournalJournal of Cardiovascular Medicine
Volume22
Issue number6
Pages (from-to)496-502
Number of pages7
ISSN1558-2027
DOIs
Publication statusPublished - 1 Jun 2021

ID: 62239279