Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
European Radiology
Published in: European Radiology 5/2020

01-05-2020 | Aortic Valve Replacement | Cardiac

Visual scoring of aortic valve calcifications on low-dose CT in lung cancer screening

Authors: Yeqing Zhu, Yong Wang, William E. Gioia, Rowena Yip, Artit C. Jirapatnakul, Michael S. Chung, David F. Yankelevitz, Claudia I. Henschke

Published in: European Radiology | Issue 5/2020

Login to get access

Abstract

Objectives

To evaluate risk factors for prevalence and progression of aortic valve calcification (AVC) in lung cancer screening participants and also to assess the sensitivity and reliability of visual AVCs on low-dose CT (LDCT) for predicting aortic stenosis (AS) in high-risk smokers.

Methods

We reviewed 1225 consecutive participants in annual LDCT screening for lung cancer at the Mount Sinai Hospital between 2010 and 2017. Sensitivity and specificity of moderate/severe AVC score on LDCT to identify AS on echocardiogram were calculated for 126 participants who had both within 12 months. Using regression analyses, risk factors for AVC at baseline, for progression, and for new AVC on annual rounds of screening were identified. Reliability of AVC assessment on LDCT was assessed by comparing visual AVC scores (1) with standard-dose, electrocardiography (ECG)-gated CT for 31 participants who had both within 12 months and (2) with Agatston scores of 1225 participants and by determining (3) the intra-reader agreement of 1225 participants.

Results

Visual AVC scores on LDCT had substantial agreement with the severity of AS on echocardiography and substantial inter-observer and excellent intra-observer agreement. Sensitivity and specificity of moderate/severe visual AVC scores for moderate/severe AS on echocardiogram were 100% and 94%, respectively. Significant predictors for baseline AVC were male sex (OR = 2.52), age (OR10 years = 2.87), and coronary artery calcification score (OR = 1.18), the significant predictor for AVC progression after baseline was pack-years of smoking (HR10 packyears = 1.14), and significant predictors for new AVC on annual LDCT were male sex (HR = 1.51), age (HR10 years = 2.17), CAC (HR = 1.09)  and BMI (HR = 1.06).

Conclusions

AVC scores on LDCT should be documented, especially in lung cancer screening program.

Key Points

• LDCT screening for lung cancer provides an opportunity to identify lung cancer and cardiovascular disease in asymptomatic smokers.
• Visual aortic valve calcification scores could be reliably evaluated on LDCT and had substantial agreement with the severity of aortic valve stenosis on echocardiography.
• Sensitivity and specificity of moderate/severe visual AVC scores on LDCT for moderate/severe AS on echocardiogram were 100% and 94%, respectively.
Appendix
Available only for authorised users
Literature
1.
Iung B, Baron G, Butchart EG et al (2003) A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Heart Disease. Eur Heart J 24:1231–1243CrossRef
2.
Nguyen V, Cimadevilla C, Estellat C et al (2015) Haemodynamic and anatomic progression of aortic stenosis. Heart 101:943–947CrossRef
3.
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 64:1202–1213CrossRef
4.
Otto CM, Lind BK, Kitzman DW, Gersh BJ, Siscovick DS (1999) Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly. N Engl J Med 341:142–147CrossRef
5.
Thomassen HK, Cioffi G, Gerdts E et al (2017) Echocardiographic aortic valve calcification and outcomes in women and men with aortic stenosis. Heart 103:1619–1624CrossRef
6.
Guerbaii RA, Fustier G, Ennezat PV et al (2017) Asymptomatic aortic stenosis: an assessment of patients’ and of their general practitioners’ knowledge, after an indexed specialized assessment in community practice. PLoS One 12:e0178932CrossRef
7.
Malaisrie SC, McDonald E, Kruse J et al (2014) Mortality while waiting for aortic valve replacement. Ann Thorac Surg 98:1564–1570 discussion 1570–1561CrossRef
8.
Baumgartner H, Hung J, Bermejo J et al (2017) Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr 30:372–392CrossRef
9.
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 97:721–726CrossRef
10.
Liu F, Coursey CA, Grahame-Clarke C et al (2006) Aortic valve calcification as an incidental finding at CT of the elderly: severity and location as predictors of aortic stenosis. AJR Am J Roentgenol 186:342–349CrossRef
11.
Cowell SJ, Newby DE, Burton J et al (2003) Aortic valve calcification on computed tomography predicts the severity of aortic stenosis. Clin Radiol 58:712–716CrossRef
12.
Messika-Zeitoun D, Aubry MC, Detaint D et al (2004) Evaluation and clinical implications of aortic valve calcification measured by electron-beam computed tomography. Circulation 110:356–362CrossRef
13.
Clavel MA, Messika-Zeitoun D, Pibarot P et al (2013) The complex nature of discordant severe calcified aortic valve disease grading: new insights from combined Doppler echocardiographic and computed tomographic study. J Am Coll Cardiol 62:2329–2338CrossRef
14.
LaBounty TM, Sundaram B, Agarwal P, Armstrong WA, Kazerooni EA, Yamada E (2008) Aortic valve area on 64-MDCT correlates with transesophageal echocardiography in aortic stenosis. AJR Am J Roentgenol 191:1652–1658CrossRef
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 241:76–82CrossRef
16.
Willmann JK, Weishaupt D, Lachat M et al (2002) Electrocardiographically gated multi-detector row CT for assessment of valvular morphology and calcification in aortic stenosis. Radiology 225:120–128CrossRef
17.
Tastet L, Enriquez-Sarano M, Capoulade R et al (2017) Impact of aortic valve calcification and sex on hemodynamic progression and clinical outcomes in AS. J Am Coll Cardiol 69:2096–2098CrossRef
18.
Lu MT, Onuma OK, Massaro JM, D’Agostino RB Sr, O’Donnell CJ, Hoffmann U (2016) Lung cancer screening eligibility in the community: cardiovascular risk factors, coronary artery calcification, and cardiovascular events. Circulation 134:897–899CrossRef
19.
Lee HY, Kim SM, Lee KS et al (2016) Quantification of aortic valve calcifications detected during lung cancer-screening CT helps stratify subjects necessitating echocardiography for aortic stenosis diagnosis. Medicine (Baltimore) 95:e3710CrossRef
20.
Gondrie MJ, van der Graaf Y, Jacobs PC, Oen AL, Mali WP, On behalf of the PROVIDI Study Group (2011) The association of incidentally detected heart valve calcification with future cardiovascular events. Eur Radiol 21:963–973CrossRef
21.
Shemesh J, Henschke CI, Farooqi A et al (2006) Frequency of coronary artery calcification on low-dose computed tomography screening for lung cancer. Clin Imaging 30:181–185CrossRef
22.
Shemesh J, Henschke CI, Shaham D et al (2010) Ordinal scoring of coronary artery calcifications on low-dose CT scans of the chest is predictive of death from cardiovascular disease. Radiology 257:541–548CrossRef
23.
Zulueta JJ, Wisnivesky JP, Henschke CI et al (2012) Emphysema scores predict death from COPD and lung cancer. Chest 141:1216–1223CrossRef
24.
Chiles C, Duan F, Gladish GW et al (2015) Association of Coronary Artery Calcification and Mortality in the National Lung Screening Trial: a comparison of three scoring methods. Radiology 276:82–90CrossRef
25.
26.
27.
Owens DS, Katz R, Takasu J, Kronmal R, Budoff MJ, O’Brien KD (2010) Incidence and progression of aortic valve calcium in the Multi-ethnic Study of Atherosclerosis (MESA). Am J Cardiol 105:701–708CrossRef
28.
Rosenhek R, Binder T, Porenta G et al (2000) Predictors of outcome in severe, asymptomatic aortic stenosis. N Engl J Med 343:611–617CrossRef
29.
Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC), European Association for Cardio-Thoracic Surgery (EACTS), Vahanian A et al (2012) Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 33:2451–2496CrossRef
30.
Nishimura RA, Otto CM, Bonow RO et al (2017) 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. J Am Coll Cardiol 70:252–289CrossRef
31.
Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174CrossRef
32.
Messika-Zeitoun D, Bielak LF, Peyser PA et al (2007) Aortic valve calcification: determinants and progression in the population. Arterioscler Thromb Vasc Biol 27:642–648CrossRef
33.
Willemink MJ, Takx RA, Isgum I et al (2015) Prognostic value of heart valve calcifications for cardiovascular events in a lung cancer screening population. Int J Cardiovasc Imaging 31:1243–1249CrossRef
34.
Coffey S, Cox B, Williams MJ (2014) The prevalence, incidence, progression, and risks of aortic valve sclerosis: a systematic review and meta-analysis. J Am Coll Cardiol 63:2852–2861CrossRef
35.
Stewart BF, Siscovick D, Lind BK et al (1997) Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study. J Am Coll Cardiol 29:630–634CrossRef
Metadata
Title
Visual scoring of aortic valve calcifications on low-dose CT in lung cancer screening
Authors
Yeqing Zhu
Yong Wang
William E. Gioia
Rowena Yip
Artit C. Jirapatnakul
Michael S. Chung
David F. Yankelevitz
Claudia I. Henschke
Publication date
01-05-2020
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 5/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-019-06614-w

Other articles of this Issue 5/2020

European Radiology 5/2020 Go to the issue

Breast

Comprehensive analyses with radiological and biological markers of breast cancer on contrast-enhanced chest CT: a single center experience using dual-layer spectral detector CT

Computed Tomography

Quantitative lobar pulmonary perfusion assessment on dual-energy CT pulmonary angiography: applications in pulmonary embolism

Musculoskeletal

Diffusion tensor imaging combined with T2 mapping to quantify changes in the skeletal muscle associated with training and endurance exercise in competitive triathletes

Oncology

Added value of MRI to endoscopic and endosonographic response assessment after neoadjuvant chemoradiotherapy in oesophageal cancer

Emergency Radiology

Refining the criteria for immediate total-body CT after severe trauma

Imaging Informatics and Artificial Intelligence

Transfer learning radiomics based on multimodal ultrasound imaging for staging liver fibrosis