期刊
HEART
卷 106, 期 24, 页码 1906-1913出版社
BMJ PUBLISHING GROUP
DOI: 10.1136/heartjnl-2020-317125
关键词
aortic stenosis; cardiac computer tomographic (CT) imaging; echocardiography
资金
- British Heart Foundation [FS/10/024, SS/CH/09/002/2636, FS/17/79/33226, FS/12/84/29814, PG12/8/29371, FS/14/78, FS/10/026, FS/14/78/31020, CH/09/002]
- NIH [R01 HL071021]
- Wellcome Trust [WT103782AIA]
- NHS Research Scotland (NRS) through NHS Lothian
- SIr Jules Thorn Award for Biomedical Research [JTA/15]
- MRC [G0701127] Funding Source: UKRI
Objective CT quantification of aortic valve calcification (CT-AVC) is useful in the assessment of aortic stenosis severity. Our objective was to assess its ability to track aortic stenosis progression compared with echocardiography. Methods Subjects were recruited in two cohorts: (1) a reproducibility cohort where patients underwent repeat CT-AVC or echocardiography within 4 weeks and (2) a disease progression cohort where patients underwent annual CT-AVC and/or echocardiography. Cohen's d-statistic (d) was computed from the ratio of annualised progression and measurement repeatability and used to estimate group sizes required to detect annualised changes in CT-AVC and echocardiography. Results A total of 33 (age 71 +/- 8) and 81 participants (age 72 +/- 8) were recruited to the reproducibility and progression cohorts, respectively. Ten CT scans (16%) were excluded from the progression cohort due to non-diagnostic image quality. Scan-rescan reproducibility was excellent for CT-AVC (limits of agreement -12% to 10 %, intraclass correlation (ICC) 0.99), peak velocity (-7% to +17%; ICC 0.92) mean gradient (-25% to 27%, ICC 0.96) and dimensionless index (-11% to +15%; ICC 0.98). Repeat measurements of aortic valve area (AVA) were less reliable (-44% to +28%, ICC 0.85). CT-AVC progressed by 152 (65-375) AU/year. For echocardiography, the median annual change in peak velocity was 0.1 (0.0-0.3) m/s/year, mean gradient 2 (0-4) mm Hg/year and AVA -0.1 (-0.2-0.0) cm(2)/year. Cohen's d-statistic was more than double for CT-AVC (d=3.12) than each echocardiographic measure (peak velocity d=0.71 ; mean gradient d=0.66; AVA d=0.59, dimensionless index d=1.41). Conclusion CT-AVC is reproducible and demonstrates larger increases over time normalised to measurement repeatability compared with echocardiographic measures.
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