Mitral annular calcification in the elderly - Quantitative assessment.

PURPOSE: To determine the reliability of subjective and objective quantification of mitral annular calcification (MAC) in elderly patients with severe aortic stenosis, to define quantitative sex- and age-related reference values of MAC, and to correlate quantitative MAC with mitral valve disease. METHODS: In this retrospective, IRB-approved study, we included 559 patients (268 females, median age 81 years, inter-quartile range 77-85 years) with severe aortic stenosis undergoing CT. Four independent readers performed subjective MAC categorization as follows: no, mild, moderate, and severe MAC. Two independent readers performed quantitative evaluation of MAC using the Agatston score method (AgatstonMAC). Mitral valve disease was determined by echocardiography. RESULTS: Subjective MAC categorization showed high inter-reader agreement for no (k â€‹= â€‹0.88) and severe MAC (k â€‹= â€‹0.75), whereas agreement for moderate (k â€‹= â€‹0.59) and mild (k â€‹= â€‹0.45) MAC was moderate. Intra-reader agreement for subjective MAC categorization was substantial (k â€‹= â€‹0.69 and 0.62). Inter- and intra-reader agreement for AgatstonMAC were excellent (ICC â€‹= â€‹0.998 and 0.999, respectively), with minor inconsistencies in MAC involving the left ventricular outflow tract/aortic valve. There were significantly more women than men with MAC (n â€‹= â€‹227, 85% versus n â€‹= â€‹209, 72%; p â€‹< â€‹0.001), with a significantly higher AgatstonMAC (median 597, range 81-2055 versus median 244; range 0-1565; p â€‹< â€‹0.001), particularly in patients ≥85 years of age. AgatstonMAC showed an area-under-the-curve of 0.84 to diagnose mitral stenosis, whereas there was no association of AgatstonMAC with mitral regurgitation (p â€‹> â€‹0.05). CONCLUSIONS: Our study in elderly patients with severe aortic stenosis shows that quantitative MAC scoring is more reliable than subjective MAC assessment. Women show higher AgatstonMAC scores than men, particularly in the elderly population. AgatstonMAC shows high accuracy to diagnose mitral stenosis.

Combining dual-source computed tomography coronary angiography and calcium scoring: added value for the assessment of coronary artery disease.

OBJECTIVE: To prospectively investigate the diagnostic accuracy of dual-source 64-slice computed tomography coronary angiography (CTCA), calcium scoring (CS) and both methods combined for assessing significant coronary artery stenoses relative to conventional coronary angiography (CCA). DESIGN, SETTING AND PATIENTS: Prospective, single-centre study conducted in a referral centre enrolling 74 consecutive patients (24 women; mean age 62 (SD 12) years) from August-October 2006. All study participants underwent CS, CTCA and CCA. Diagnostic accuracy was calculated for CS, CTCA and both methods combined relative to CCA. Not-evaluative segments at computed tomography were considered false positive. RESULTS: CCA identified 139 stenoses in 36 patients. Average heart rate during CTCA was 68 (13) bpm (range 35-102 bpm), and 2% of segments (21/1001) in 11% of patients (8/74) were not evaluative. Considering these as false positives, per-patient sensitivity and specificity was 98% and 87%. When using CS cut-off values of 0 to exclude and >or=400 to predict stenosis, sensitivity and specificity of CS was 100% and 70%, respectively. Combining CS and CTCA in all patients correctly reclassified five patients, while six were falsely classified as stenotic, all of them correctly classified with CTCA alone. Using CS only in patients with not-evaluative segments correctly reclassified five patients while avoiding misclassifications (sensitivity 98%, specificity 100%). CONCLUSION: Dual-source CTCA allows the diagnosis of significant stenoses with a high diagnostic accuracy. Selectively combining CS with CTCA in patients with not-evaluative coronary segments improves specificity from 87% to 100% without decreasing the high sensitivity of 98%.