Influence of aortic valve leaflet calcification on dynamic aortic valve motion assessed by cardiac computed tomography

Abstract

Background: Computed tomography is the best noninvasive imaging modality for evaluating valve leaflet calcification.

Objective: To evaluate the association of aortic valve leaflet calcification with instantaneous valve opening and closing using dynamic multidetector computed tomography (MDCT).

Methods: We retrospectively evaluated 58 consecutive patients who underwent dynamic MDCT imaging. Aortic valve calcification (AVC) was quantified using the Agatston method. The aortic valve area (AVA) tracking curves were derived by planimetry during the cardiac cycle using all 20 phases (5% reconstruction). da/dt in cm²/s was calculated as the rate of change of AVA during opening (positive) or closing (negative). Patients were divided into 3 three groups according to Agatston score quartile: no AVC (Q2, Score 0, n = 18), mild AVC (Q3, Score 1-2254, n = 24), and severe AVC (Q4 Score >2254, n = 14).

Results: In multivariable linear regression, compared to the non AVC group, the mild and severe AVC groups had lower maximum AVA (by -1.71 cm² and -2.25 cm², respectively), lower peak positive da/dt (by -21.88 cm²/s and -26.65 cm²/s, respectively), and higher peak negative da/dt (by 13.78 cm²/s and 18.11 cm²/s, respectively) (p < 0.05 for all comparisons).

Conclusions: AVA and its opening and closing were influenced by leaflet calcification. The present study demonstrates the ability of dynamic MDCT imaging to assess quantitative aortic valve motion in a clinical setting.

Keywords: Aortic valve stenosis; Calcium score; Coronary angiography; Diagnosis; Echocardiography; Heart failure; Imaging.