Correlation Between Cardiac Computed Tomography and Histopathology for Evaluating Patients with Aortic Valve Disease

Abstract

Background: The use of cardiac computed tomography (cardiac CT) and the quantification of the Agatston score for the evaluation of calcium of the aortic valve (AVC) has increased in different clinical contexts for diagnostic and prognostic purposes. This study aims to evaluate the correlation between cardiac CT and histopathology for the quantification of AVC.

Methods: Ninety patients diagnosed with severe aortic valve dysfunction, of any etiology and regardless of the predominant type of injury, were included. Before the surgical event, a Cardiac CT were performed with Agatston Score measurement. The removed native valve was evaluated by a Pathologist, who provided a qualitative and quantitative evaluation of valve calcium. Calcium density was also analyzed by quantifying the area in pixel units obtained from photomicrographs. Follow-up was performed for four years after the aortic valve replacement.

Results: Ninety patients were analyzed. The degenerative etiology predominated 63.3% (57 patients). The calcium load was different for the gender (p = 0.01) and type of valve injury (p = 0.0013). There was a positive correlation between the Agatston score, and the percentage of calcium reported by the pathologist in a conventional qualitative way (rs = 0.75, p < 0.001) and between the AVC and the Cote et al. score (rs = 0.77, p < 0.001). There was no difference in survival after aortic valve replacement concerning valve calcium load. Left ventricular dysfunction showed a significant difference in survival (p = 0.003, Log-rank).

Conclusion: There is a moderately high correlation between the Agatston score quantified by Cardiac CT and the histopathological evaluation. The severity of the calcification did not prove to be a predictor of death in the postsurgical follow-up.

Keywords: Agatston Score; Aortic valve disease; Aortic valve replacement; Cardiac CT; Histopathology.