TY - JOUR
T1 - Association of aortic valve size with the degree of aortic valve calcification in severe high-gradient aortic stenosis
AU - Mousavi, Roya Anahita
AU - Lamm, Gudrun
AU - Will, Maximilian
AU - Kammerlander, Andreas A
AU - Krackowizer, Philip
AU - Gunacker, Petra Carmen
AU - Höbart, Philipp
AU - Voith, Nikolaus
AU - Grüninger, Marc Felix
AU - Schwarz, Konstantin
AU - Vock, Paul
AU - Hoppe, Uta C
AU - Mascherbauer, Julia
N1 - © The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2025/1/15
Y1 - 2025/1/15
N2 - AIMS: Less pronounced calcification of the aortic valve (AVC) was observed in women with aortic stenosis (AS) as compared to men. Since women have smaller aortic valves (AV), this could explain a lower calcium load. We aimed to analyze the association of AV size with AVC independent from sex.METHODS & RESULTS: Consecutive patients with high-gradient AS, who underwent cardiac computed tomography (CT), were assessed. AV annulus area and AVC with the Agatston score were measured on CT. In total, 601 patients (mean age 80±7 years, 45% female) were included. Women had smaller AV annulus areas (4.12±0.67cm2 vs 5.15 ±0.78cm2, p<0.001) and lower Agatston scores (2018 [1456-3017] vs. 3394 [2562-4530]; p<0.001) than men. We found a significant correlation (r=0.594, p<0.001) and independent association (β=926.20, p<0.001) of AV annulus area with AVC. On separate regression analyses for men and women, AVC was independently associated with AV annulus area in both sexes (βmen=887.77; βwomen=863.48, both p<0.001). When patients were stratified into AV size quartiles, patients in the lower quartiles were more likely to have AVC values below recommended sex-specific AVC thresholds. In the lowest quartile 28% of female and 27% of male patients had Agatston scores below 1200AU (women) and 2000AU (men) while this proportion decreased to 6% and 2%, respectively, in the quartiles with the largest annulus areas.CONCLUSION: In high-gradient AS, AVC strongly depends on AV annulus area. This association is not dependent on sex. Thus, AVC should be indexed to AV size in addition to sex.
AB - AIMS: Less pronounced calcification of the aortic valve (AVC) was observed in women with aortic stenosis (AS) as compared to men. Since women have smaller aortic valves (AV), this could explain a lower calcium load. We aimed to analyze the association of AV size with AVC independent from sex.METHODS & RESULTS: Consecutive patients with high-gradient AS, who underwent cardiac computed tomography (CT), were assessed. AV annulus area and AVC with the Agatston score were measured on CT. In total, 601 patients (mean age 80±7 years, 45% female) were included. Women had smaller AV annulus areas (4.12±0.67cm2 vs 5.15 ±0.78cm2, p<0.001) and lower Agatston scores (2018 [1456-3017] vs. 3394 [2562-4530]; p<0.001) than men. We found a significant correlation (r=0.594, p<0.001) and independent association (β=926.20, p<0.001) of AV annulus area with AVC. On separate regression analyses for men and women, AVC was independently associated with AV annulus area in both sexes (βmen=887.77; βwomen=863.48, both p<0.001). When patients were stratified into AV size quartiles, patients in the lower quartiles were more likely to have AVC values below recommended sex-specific AVC thresholds. In the lowest quartile 28% of female and 27% of male patients had Agatston scores below 1200AU (women) and 2000AU (men) while this proportion decreased to 6% and 2%, respectively, in the quartiles with the largest annulus areas.CONCLUSION: In high-gradient AS, AVC strongly depends on AV annulus area. This association is not dependent on sex. Thus, AVC should be indexed to AV size in addition to sex.
U2 - 10.1093/ehjci/jeaf002
DO - 10.1093/ehjci/jeaf002
M3 - Journal article
C2 - 39812179
SN - 2047-2404
JO - European Heart Journal Cardiovascular Imaging
JF - European Heart Journal Cardiovascular Imaging
ER -