Preoperative Computed Tomography Angiography Reveals Leaflet-Specific Calcification and Excursion Patterns in Aortic Stenosis

作者：Ian Y. Chen, Vijay Vedula, Sachin B. Malik, Tie Liang, Andrew Y. Chang, Kieran S. Chung, Nazish Sayed, Philip S. Tsao, John C. Giacomini, Alison L. Marsden, Joseph C. Wu · 发表于：Circulation Cardiovascular Imaging · 年份：2021 · DOI：10.1161/circimaging.121.012884 · 被引用次数：15 · 研究领域：Cardiac Valve Diseases and Treatments、Cardiac Imaging and Diagnostics、Coronary Interventions and Diagnostics

Background: Computed tomography–based evaluation of aortic stenosis (AS) by calcium scoring does not consider interleaflet differences in leaflet characteristics. Here, we sought to examine the functional implications of these differences. Methods: We retrospectively reviewed the computed tomography angiograms of 200 male patients with degenerative calcific AS undergoing transcatheter aortic valve replacement and 20 male patients with normal aortic valves. We compared the computed tomography angiography (CTA)-derived aortic valve leaflet calcification load (AVLC CTA ), appearance, and systolic leaflet excursion (LE sys ) of individual leaflets. We performed computer simulations of normal valves to investigate how interleaflet differences in LE sys affect aortic valve area. We used linear regression to identify predictors of leaflet-specific calcification in patients with AS. Results: In patients with AS, the noncoronary cusp (NCC) carried the greatest AVLC CTA (365.9 [237.3–595.4] Agatston unit), compared to the left coronary cusp (LCC, 278.5 [169.2–478.8] Agatston unit) and the right coronary cusp (RCC, 240.6 [137.3–439.0] Agatston unit; both P <0.001). However, LCC conferred the least LE sys (42.8° [38.8°–49.0°]) compared to NCC (44.8° [41.1°–49.78°], P =0.001) and RCC (47.7° [42.0°–52.3°], P <0.001) and was more often characterized as predominantly thickened (23.5%) compared to NCC (12.5%) and RCC (16.5%). Computer simulations of normal valves revealed greater reduct...