Yamato Shimomiya, Presenter: Nothing to Disclose

Michinobu Nagao MD, Abstract Co-Author: Research Grant, Bayer AG Research Grant, Koninklijke Philips NV

Satoshi Kawanami MD, Abstract Co-Author: Research Grant, Modest Research Grant, Bayer AG Research Grant, Koninklijke Philips NV

Masato Yonezawa, Abstract Co-Author: Nothing to Disclose

Yuzo Yamasaki MD, Abstract Co-Author: Nothing to Disclose

Hiroshi Honda MD, Abstract Co-Author: Nothing to Disclose

Shinya Takarabe RT, Abstract Co-Author: Nothing to Disclose

Masatoshi Kondo, Abstract Co-Author: Nothing to Disclose

hiroshi hamasaki, Abstract Co-Author: Nothing to Disclose

Takashi Shirasaka BS, Abstract Co-Author: Nothing to Disclose

Masayuki Tachibana, Abstract Co-Author: Nothing to Disclose

Yasuhiko Nakamura RT, Abstract Co-Author: Nothing to Disclose

When treating aortic stenosis (AS), accurate aortic valve area (AVA) measurement is critical for appropriate patient selection and successful transcatheter aortic valve implantation. CT could detail the AVA shape and length, but it is limited by motion and calcification artifacts. Therefore, we propose a new objective index to determine the AS severity.

A total 33 patients (mean age, 78 years) diagnosed with AS who underwent surgical aortic valve replacement and ECG-gated 256-slice coronary CT angiography and echocardiography were retrospectively reviewed. In addition, 12 patients (mean age, 65 years) with no cardiac disease history or coronary stenosis on CT were enrolled as controls. The valsalva sinus distensibility (VD) index was defined the ratio between the Valsalva sinus area (mm2) and the minor axis of aortic annulus (mm) at end-systole using multiplanar reconstructed CT. The volume of valve caps measuring >800 Hounsfield units was designated as the calcium volume (mm3) at end-diastole. Severe AS was defined as an AVA <75 mm2 on echocardiography. Parameters were compared between the two groups using the Mann–Whitney U test. The diagnostic utility of AS was determined by receiver-operating-characteristics (ROC) curve analysis.

The VD index was significantly lower in the AS patients than in the controls (34 ± 6 vs. 41 ± 4, p = 0.0005). ROC analysis revealed a 39 optimal VD index for identifying AS patients with a 0.85 C-statistics, 79% sensitivity, and 83% specificity. In 33 patients with AS, the VD index was significantly lower in patients with an AVA <75 mm2 than those with an AVA >75 mm2 (31 ± 5 vs. 37 ± 7, p < 0.05). There was no significant difference in the calcium volume between the two groups (257 ± 256 mm3 vs. 190 ± 175 mm3). ROC analysis identified a 34 optimal VD index for identifying AS patients with an AVA < 75 mm2, 0.75 C-statistics, 78% sensitivity, and 70% specificity.

Decreased Valsalva sinus distensibility is a characteristic feature of AS. The VD index may enable an accurate assessment of aortic stenosis in calcified valve caps.

Valsalva sinus distensibiity is an objective measurement for AS severity and is useful in therapeutic planning of transcatheter aortic valve implantation.

Shimomiya, Y, Nagao, M, Kawanami, S, Yonezawa, M, Yamasaki, Y, Honda, H, Takarabe, S, Kondo, M, hamasaki, h, Shirasaka, T, Tachibana, M, Nakamura, Y, Clinical Impact of Valsalva Sinus Distensibility in Aortic Stenosis: Quantification by 256-slice Coronary CT Angiography.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14018218.html