Accuracy of Echocardiographic Visual Assessment of Aortic Valve Calcification –Comparison with Quantitative Calcium Score Analysis - The 65th Annual Conference of the Israel Heart Society & The Israel Society of Cardiothoracic Surgery, 24-25 April 2018

Ariel Verbner Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel Adi Butnaro Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel David Rosenmann Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel Naama Bogot Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel Giora Weisz Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel Michael Glickson Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel Arik Wolak Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel

Background – Computed Tomography (CT) is the preferred modality for an accurate and quantitative assessment of Aortic Valve Calcification (AVC). However, being used routinely and more commonly, echocardiography may allow a qualitative visual assessment as well. Since there is only a little evidence as to the correlation of AVC assessment between these modalities, the current study aimed to investigate this issue.

Methods – We enrolled 100 consecutive patients who underwent cardiac CT and echocardiography within six months. Fifty patients underwent CT before TAVI procedure, while in 50 the indication was coronary assessment. All CT studies included a non-contrast gated scan for calcium evaluation using standard parameters. All echo studies images were blindly reviewed by a trained echocardiographer, who classified the AVC into four categories – none, mild, moderate and severe. All studies were analyzed for aortic valve Agatston score using Syngovia v.3.14 calcium score application. Statistical analysis was performed by SPSS, using weighted kappa test.

Results – The patients` age was 69±14, 54% male. The mean AVC was 1426±1800 SD. By echocardiography 24(24%), 22(22%), 27(27%) and 27(27%) of the patients were classified into none, mild, moderate and severe AVC, respectively. AVC scores by CT were divided into groups using empiric thresholds (20, 500, 1100) for AVC grading as suggested by Sarano et al. (2004), and were classified into the same categories. Agreements between the modalities among the whole group, non-TAVI patients, and TAVI patients were good (K= 0.68), moderate (K=0.527) and fair (K=0.23), respectively.

Conclusion – Agreement between echocardiographic visual assessment and quantitative CT AVC is related to the severity of the AVC. At the extreme (i.e., no calcifications and severely calcified valve), echocardiography can accurately identify the grade of calcifications. However, echocardiography is limited to define accurately and reliably AVC in the intermediate zone (i.e., mildly and moderately AVC).