Evaluation of aortic valve calcifications with multidetector computed tomography

Aortic stenosis is the most common valvular heart disease and its incidence in developed countries is increasing as the elderly population grows. There are few studies that evaluate incidental calcifications in a practical manner and demonstrate their clinical correlation and prognostic significance. In our study, we aimed to evaluate the relation of incidental aortic valve calcifications and mitral valve, coronary artery and aortic-supraaortic calcifications, and diameter of ascending aorta, and assess the correlation of a practical scoring scheme with the severity of aortic stenosis as detected in echocardiography. 367 patients who had chest CTs taken in our department between April 2012 and June 2013 and who had been examined with echocardiography in our hospital were included in the study. CT images of these patients were evaluated, scored for aortic valve, mitral valve, coronary artery and aortic-supraaortic calcification and the diameter of their ascending aorta was measured. The relationship between these parameters and the severity of aortic stenosis as detected with echocardiography, as well as the correlation of the scored parameters amongst each other were evaluated with statistical methods. At the end of the study, the positive predictive value of aortic valve calcification for presence of aortic stenosus was found to be 24% whereas the negative predictive value was 94%. The severity of aortic stenosis and scores of aortic valve, mitral valve, coronary arteries and aortic-supraaortic calcification were found to be statistically significantly related. Besides that, a moderate correlation was found between coronary artery, aortic valve and aortic-supraaortic calcification scores; diameter of ascending aorta was shown to have an extremely weak correlation with mitral valve calcification and severity of aortic stenosis; and a weak correlation was determined amongst all other parameters. Our study demonstrates that a simple scoring scheme for incidental aortic valve calcifications is related to the severity of aortic stenosis. Furthermore, the results suggest that an incidental detection of calcification in any one of these sites could act as a warning for careful evaluation of the others. The simpler scoring method we used is correlated to the severity of stenosis and is a practical method suitable for the purpose of fast evaluation of incidental findings Key words: Aortic stenosis, aortic valve, calcification, computerized tomography, echocardiography.