Skip to main content
SpringerLink
Log in

The significance of aortic valve calcification in patients with bicuspid aortic valve disease

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

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. 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. 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 0.855 with a cutoff value of 897 (sensitivity 86.7 %, specificity 72.2 %). Conclusively, aortic calcium score calculated by quantitative CT is a reliable marker in evaluating severity of AS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ward C (2000) Clinical significance of the bicuspid aortic valve. Heart 83(1):81–85

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Siu SC, Silversides CK (2010) Bicuspid aortic valve disease. J Am Coll Cardiol 55(25):2789–2800

    Article  PubMed  Google Scholar 

  3. Hope MD, Urbania TH, Yu JP, Chitsaz S, Tseng E (2012) Incidental aortic valve calcification on CT scans: significance for bicuspid and tricuspid valve disease. Acad Radiol 19(5):542–547

    Article  PubMed  Google Scholar 

  4. Pomerance A (1972) Pathogenesis of aortic stenosis and its relation to age. Br Heart J 34(6):569–574

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  5. Cueff C, Serfaty JM, Cimadevilla C et al (2011) Measurement of aortic valve calcification using multislice computed tomography: correlation with haemodynamic severity of aortic stenosis and clinical implication for patients with low ejection fraction. Heart 97(9):721–726

    Article  PubMed  Google Scholar 

  6. Koos R, Mahnken AH, Sinha AM, Wildberger JE, Hoffmann R, Kuhl HP (2004) Aortic valve calcification as a marker for aortic stenosis severity: assessment on 16-MDCT. AJR Am J Roentgenol 183(6):1813–1818

    Article  PubMed  Google Scholar 

  7. Clavel MA, Pibarot P, Messika-Zeitoun D et al (2014) Impact of aortic valve calcification, as measured by MDCT, on survival in patients with aortic stenosis: results of an international registry study. J Am Coll Cardiol 64(12):1202–1213

    Article  PubMed Central  PubMed  Google Scholar 

  8. Shin HJ, Shin JK, Chee HK, Kim JS, Ko SM (2015) Characteristics of aortic valve dysfunction and ascending aorta dimensions according to bicuspid aortic valve morphology. Eur Radiol 25(7):2103–2114

    Article  PubMed  Google Scholar 

  9. Nishimura RA, Otto CM, Bonow RO et al (2014) 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 63(22):2438–2488

    Article  PubMed  Google Scholar 

  10. Song JK (2015) Bicuspid aortic valve: unresolved issues and role of imaging specialists. J Cardiovasc Ultrasound 23(1):1–7

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  11. Kang JW, Song HG, Yang DH et al (2013) Association between bicuspid aortic valve phenotype and patterns of valvular dysfunction and bicuspid aortopathy: comprehensive evaluation using MDCT and echocardiography. JACC Cardiovasc Imaging 6(2):150–161

    Article  PubMed  Google Scholar 

  12. Jackson V, Petrini J, Eriksson MJ, Caidahl K, Eriksson P, Franco-Cereceda A (2014) Aortic dimensions in relation to bicuspid and tricuspid aortic valve pathology. J Heart Valve Dis 23(4):463–472

    PubMed  Google Scholar 

  13. Bissell MM, Hess AT, Biasiolli L et al (2013) Aortic dilation in bicuspid aortic valve disease: flow pattern is a major contributor and differs with valve fusion type. Circ Cardiovasc Imaging 6(4):499–507

    Article  PubMed  Google Scholar 

  14. Beroukhim RS, Kruzick TL, Taylor AL, Gao D, Yetman AT (2006) Progression of aortic dilation in children with a functionally normal bicuspid aortic valve. Am J Cardiol 98(6):828–830

    Article  PubMed  Google Scholar 

  15. Koos R, Kuhl HP, Muhlenbruch G, Wildberger JE, Gunther RW, Mahnken AH (2006) Prevalence and clinical importance of aortic valve calcification detected incidentally on CT scans: comparison with echocardiography. Radiology 241(1):76–82

    Article  PubMed  Google Scholar 

  16. O’Sullivan CJ, Windecker S (2013) Implications of bicuspid aortic valves for transcatheter aortic valve implantation. Circ Cardiovasc Interv 3(6):204–206

    Article  Google Scholar 

  17. Jilaihawi H, Wu Y, Yang Y et al (2015) Morphological characteristics of severe aortic stenosis in China: imaging corelab observations from the first Chinese transcatheter aortic valve trial. Catheter Cardiovasc Interv 85(suppl 1):752–761

    Article  PubMed  Google Scholar 

  18. Silverman MG, Harkness JR, Blankstein R et al (2014) Baseline subclinical atherosclerosis burden and distribution are associated with frequency and mode of future coronary revascularization: multi-ethnic study of atherosclerosis. JACC Cardiovasc Imaging 7(5):476–486

    Article  PubMed Central  PubMed  Google Scholar 

  19. Natorska J, Undas A (2015) Blood coagulation and fibrinolysis in aortic valve stenosis: links with inflammation and calcification. Thromb Haemost. doi:10.1160/TH14-10-0861

    PubMed  Google Scholar 

  20. Jackson V, Eriksson MJ, Caidahl K, Eriksson P, Franco-Cereceda A (2014) Ascending aortic dilatation is rarely associated with coronary artery disease regardless of aortic valve morphology. J Thorac Cardiovasc Surg 148(6):2973–2980

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The study was granted by the Capital Special Project of Health Research and Development (2011-4003-01).

Author information

Authors and Affiliations

  1. Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China

    Xinshuang Ren, Kun Liu, Zhihui Hou, Yang Gao, Weihua Yin, Zhennan Li & Bin Lu

  2. Department of Ultrasound, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China

    Minghui Zhang

  3. Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, 100029, China

    Zhiqiang Wang

Authors
  1. Xinshuang Ren
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Minghui Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kun Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zhihui Hou
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yang Gao
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Weihua Yin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Zhiqiang Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Zhennan Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Bin Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bin Lu.

Ethics declarations

Conflict of interest

None.

Ethical standards

Our study was a retrospective study, all the data were collected through electronic medical records in our institution with ethical approval and analyzed anonymously. Informed consent was not available because no change was applied to patients’ treatment.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ren, X., Zhang, M., Liu, K. et al. The significance of aortic valve calcification in patients with bicuspid aortic valve disease. Int J Cardiovasc Imaging 32, 471–478 (2016). https://doi.org/10.1007/s10554-015-0783-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-015-0783-y

Keywords

Search

Navigation