The Application Of CT Angiography In Aortic Valve Disease

Objective:To evaluate the characteristics of aortic valve dysfunction and ascending aorta dimension in patients with different bicuspid aortic valve(BAV)morphology.Methods:A total of 197 patients who underwent aortic valve replacement and were diagnosed with BAV by pathology were included.Basic clinical data and echocardiographic data were retrospectively reviewed and recorded.Patients were classified according to the presence(raphe+)or absence(raphe-)of raphe and fusion type of the cusps(BAV-LR,fusion of left and right cusp;BAV-L/RN,fusion of left/right and noncoronary cusp).Clinical characteristics,valve dysfunction and ascending aorta dimension were compared between patients with different valve morphology.Results:Aortic regurgitation(AR)were more common in BAV-raphe+(61.5%vs 22.7%,p<0.001)and BAV-LR patients(59.2%vs 18.1%,p<0.001).Aortic stenosis(AS)were more common in BAV-raphe-(69.3%vs22.9%,p<0.001)and BAV-L/RN(68.1%vs29.6%,p<0.001)patients.In BAV-raphe+ patients,AR was more common in BAV-LR patients(73.3%vs17.4%,p<0.001)and AS was more common in BAV-L/RN patients(52.2%vs15.1%,p=0.001).Aortic root dilation was more common in BAV-raphe+ patients than BAV-raphe-patients(23.9%vs 10.2%,p=0.024).Aortic root and ascending aorta dilation was more common in BAV-L/RN patients than BAV-LR patients(37.5%vs 10.6%,p=0.006).Conclusion:The morphological characteristics of BAV was associated with the type of valvular dysfunction,and location of an ascending aorta dilatation.Objectives:Bicuspid aortic valve(BAV)is a common congenital heart disease.Our study was to analyze clinical features of BAV and evaluate whether aortic valve calcium score(AVCS)was a reliable marker for aortic stenosis(AS)in patients with BAV.Methods:101 patients with BAV who both underwent echocardiology and cardiac computed tomography(CT)scan in our institution were included.Basic clinical data,haemodynamic feature,aortic valve and coronary calcium score were collected and compared among patients with different valve function and different degree of AS.Risk factors related to severe AS were evaluated by logistic regression,and a receiver operative characteristic curve was used to determine the cutoff calcium score greater than which the diagnosis of severe AS was optimized.Results:Patients with aortic regurgitation(AR)were younger and demonstrated larger aortic annulus and sinus compared with patients with other valve dysfunction.Aortic valve calcium score was higher in patients with AS than with AR.For patients with different degree of AS,there were statistical significances in the value of age,aortic valve calcium score and coronary calcium score.AVCS was positively related to severe AS with an odd ratio of 1.286(95%CI 1.099-1.504)by every 300 points increase.AVCS was also a strong predictor for severe AS with area under the curve(AUC)0.855 with a cutoff value of 897(sensitivity 86.7%,specificity 72.2%).Conclusion:Aortic calcium score calculated by quantitative CT is a reliable marker in evaluating severity of AS.Objectives:To investigate the feasibility,image quality,and safety of low-tube-voltage,low iodine load iso-osmolar contrast comprehensive cardiac and aortoiliac CT angiography(CTA)for transcatheter aortic valve replacement(TAVR)planning.Methods:98 consecutive TAVR candidates(men,mean age)prospectively underwent combined contrast-enhanced CTA of the aortic root complex and vascular access route.Patients were assigned to group A(2nd generation dual-source CT[DSCT],100kV,contrast 270 mgI/mL iodixanol)or group B(2nd generation dual-source CT[DSCT],120kV,contrast 370mgI/mL).Contrast volume was set according to the body mass index(BMI)when capturing cardiac CT image(BMI<=24kg/m2,50ml;24<BMI<=28kg/m2,55ml;BMI>28kg/m2,60ml)and the flow rate was 4.5ml/s.20ml contrast was added when acquiring vascular image with flow rate of 2ml/s.Mean vascular attenuation,noise,signal-to-noise ratio(SNR),and contrast-to-noise ratio(CNR)of aortic root,aortic arch,descending aorta at level of diaphragm,renal artery and femoral artery were compared.Subjective image quality was assessed by two observers using five-point Likert scales.Patient creatinine levels before the examination of CTA and during follow-up(24h-48h)were measured.Results:Patients' characteristics between experiment group and control group were similar(P>0.1).There was no significant difference in subjective image quality score between two groups including aortic root image,coronary artery image and whole aorta image.Image noise in experiment group was higher than that in control group(p<0.05).Intravascular attenuation in left and right femoral artery were lower in experiment group than these in control group(p1=0.021;p2=0.018),image noise were higher(p1=0.034;p2=0.023),SNR were lower(pl=0.026;p2=0.020)and CNR were lower(pl=0.040;p2=0.035)in experimental group.Radiation dose in experimental group was higher than control group(p=0.001).There were no significant changes in creatinine levels among and between groups during the follow-up.Conclusion:TAVR candidates can be safely and effectively evaluated by a comprehensive CTA protocol with low iodine load iso-osmolar contrast using low-tube-voltage acquisition.Objective:To investigate risk factors associated with postoperative paravalvular leak in patients underwent thanscatheter aortic valve replacement.Methods:Patients underwent thanscatheter aortic valve replacement in our hospital since January 2012 to May 2016 were included in our study.Basic clinical data,haemodynamic feature,aortic valve calcium score were collected and compared among patients with different degree of postoperative paravalvular leak.Multivariaous logistic regression was used to investigate risk factors associated with postoperative paravalvular leak,and a receiver operative characteristic curve was used to determine the cutoff calcium score greater than which the diagnosis of paravalvular leak was optimized.Results:86 patients were included in our study,56 patients had tricuspid aortic valve and 30 patients had bicuspid aortic valve.The average age was 75.89 ± 6.07,and 55.8%patients were male.50 patients didn't have postoperative paravalvular leak,30 patients with mild postoperative paravalvular leak and 6 patients with moderate-severe paravalvular leak.Patients with paravalvular leak had higher aortic valve calcium score(mild paravalvular leak vs no paravalvular leak,4674.16 ±2178.25 vs 3371.13 ± 1375.54,p=0.003;moderate-severe paravalvular leak vs no paravalvular leak,5901.24 ±2613.82 vs 3371.13 ± 1375.54,p=0.002).Aortic valve calcium score was positively related to paravalvular leak with an odd ratio of 1.629(95%CI 1.227-2.164)by every 1000 points increase.Aortic valve calcium score was also a strong predictor for paravalvular leak with area under the curve(AUC)0.703 with a cutoff value of 3582(sensitivity 66.7%,specificity 66.0%).Conclusion:Aortic calcium score calculated by quantitative CT is a reliable marker in predicting paravalvular leak after thanscatheter aortic valve replacement.