Characterization of Aortic Valve Stenosis by CT Angiography in a Diverse US Cohort

Daniel Lorenzatti; Annalisa Filtz; Pamela Pina; Jolien Geers; Jake Gilman; Jonathan Daich; Paul Ippolito; Abdullah Aftab; Aldo L. Schenone; Carlos A. Gongora; Justin Johannesen; Andrea Scotti; Edwin C. Ho; Mario J. Garcia; Azeem Latib; Carlos J. Rodriguez; Daniel S. Berman; Marie Annick Clavel; Philippe Pibarot; Robert O. Bonow; Piotr J. Slomka; Marc R. Dweck; Damini Dey; Leandro Slipczuk

doi:10.1161/CIRCIMAGING.124.017858

Characterization of Aortic Valve Stenosis by CT Angiography in a Diverse US Cohort

Daniel Lorenzatti, Annalisa Filtz, Pamela Pina, Jolien Geers, Jake Gilman, Jonathan Daich, Paul Ippolito, Abdullah Aftab, Aldo L. Schenone, Carlos A. Gongora, Justin Johannesen, Andrea Scotti, Edwin C. Ho, Mario J. Garcia, Azeem Latib, Carlos J. Rodriguez, Daniel S. Berman, Marie Annick Clavel, Philippe Pibarot, Robert O. BonowPiotr J. Slomka, Marc R. Dweck, Damini Dey, Leandro Slipczuk^*

^*Corresponding author for this work

Medicine, Cardiology Division

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Aortic stenosis (AS) involves calcific and fibrotic degeneration of the valve tissue. The only noninvasive method for evaluating both processes is contrast-enhanced computed tomography angiography. We aimed to explore the differences in aortic valve (AV) tissue composition across sex, race/ethnicity, and AS hemodynamic phenotype in US patients referred for transcatheter AV replacement planning. METHODS: We retrospectively analyzed symptomatic patients with AS who underwent computed tomography angiography for transcatheter AV replacement planning between 2015 and 2022. Using semi-automated software, we quantified the AV tissue composition by fibrotic, calcific, and fibro-calcific volumes, and the fibro-calcific ratio (fibrotic/calcific volume) as a measure of valve phenotype. RESULTS: The study included 651 patients (mean age 84 years; 55% women) with 38% non-Hispanic (NH)-White, 27% Hispanic, and 13% NH-Black. Women had lower fibro-calcific (230 versus 293 mm^3/cm2; P<0.001) and calcific volumes (85 versus 149 mm^3/cm2; P<0.001), and higher fibro-calcific ratio (1.47 versus 0.83; P<0.001). No differences were observed in the fibrotic volumes (P=0.805). NH-White women had higher fibro-calcific (256 mm^3/cm2, P=0.002) and fibrotic volumes (145 mm^3/cm2; P<0.001), and fibro-calcific ratio (1.57; P=0.01) compared with Hispanic and NH-Black women. No differences were found among men. High-gradient AS had higher fibro-calcific (295 versus 219 mm³/cm²; P<0.001) and calcific volumes (148 versus 88 mm³/cm²; P<0.001), and a lower fibro-calcific ratio (0.90 versus 1.45; P<0.001), although no difference in fibrotic volume (P=0.099) compared with low-gradient AS. CONCLUSIONS: Phenotypic differences in computed tomography angiography valve tissue composition exist in patients with AS referred for transcatheter AV replacement, with women and low-gradient AS showing a proportionally more fibrotic phenotype. NH-White women have the highest fibrotic tissue composition, and no differences are evident among men.

Original language	English (US)
Article number	e017858
Journal	Circulation: Cardiovascular Imaging
Volume	18
Issue number	6
DOIs	https://doi.org/10.1161/CIRCIMAGING.124.017858
State	Published - Jun 1 2025

Funding

Drs Filtz, Lorenzatti, and Slipczuk are supported by institutional grants from Amgen and Philips. Dr Dey received grant support from the National Heart, Lung, and Blood Institute, software royalties from Cedars-Sinai Medical Center, and holds a patent (US8885905B2in USA and WO patent WO2011069120A1, Method and System for Plaque Characterization). Dr Ho reports consulting/advisory board relationships with GE, Philips, Edwards Lifesciences, Medtronic, Abbott. The other authors report no conflicts.

Keywords

aortic valve
aortic valve stenosis
computed tomography angiography
heart valve diseases
racial groups
sex

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging
Cardiology and Cardiovascular Medicine

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10.1161/CIRCIMAGING.124.017858

Cite this

Lorenzatti, D., Filtz, A., Pina, P., Geers, J., Gilman, J., Daich, J., Ippolito, P., Aftab, A., Schenone, A. L., Gongora, C. A., Johannesen, J., Scotti, A., Ho, E. C., Garcia, M. J., Latib, A., Rodriguez, C. J., Berman, D. S., Clavel, M. A., Pibarot, P., ... Slipczuk, L. (2025). Characterization of Aortic Valve Stenosis by CT Angiography in a Diverse US Cohort. Circulation: Cardiovascular Imaging, 18(6), Article e017858. https://doi.org/10.1161/CIRCIMAGING.124.017858

@article{15433e6003f1448e9300cccbfda69642,

title = "Characterization of Aortic Valve Stenosis by CT Angiography in a Diverse US Cohort",

abstract = "BACKGROUND: Aortic stenosis (AS) involves calcific and fibrotic degeneration of the valve tissue. The only noninvasive method for evaluating both processes is contrast-enhanced computed tomography angiography. We aimed to explore the differences in aortic valve (AV) tissue composition across sex, race/ethnicity, and AS hemodynamic phenotype in US patients referred for transcatheter AV replacement planning. METHODS: We retrospectively analyzed symptomatic patients with AS who underwent computed tomography angiography for transcatheter AV replacement planning between 2015 and 2022. Using semi-automated software, we quantified the AV tissue composition by fibrotic, calcific, and fibro-calcific volumes, and the fibro-calcific ratio (fibrotic/calcific volume) as a measure of valve phenotype. RESULTS: The study included 651 patients (mean age 84 years; 55% women) with 38% non-Hispanic (NH)-White, 27% Hispanic, and 13% NH-Black. Women had lower fibro-calcific (230 versus 293 mm3/cm2; P<0.001) and calcific volumes (85 versus 149 mm3/cm2; P<0.001), and higher fibro-calcific ratio (1.47 versus 0.83; P<0.001). No differences were observed in the fibrotic volumes (P=0.805). NH-White women had higher fibro-calcific (256 mm3/cm2, P=0.002) and fibrotic volumes (145 mm3/cm2; P<0.001), and fibro-calcific ratio (1.57; P=0.01) compared with Hispanic and NH-Black women. No differences were found among men. High-gradient AS had higher fibro-calcific (295 versus 219 mm3/cm2; P<0.001) and calcific volumes (148 versus 88 mm3/cm2; P<0.001), and a lower fibro-calcific ratio (0.90 versus 1.45; P<0.001), although no difference in fibrotic volume (P=0.099) compared with low-gradient AS. CONCLUSIONS: Phenotypic differences in computed tomography angiography valve tissue composition exist in patients with AS referred for transcatheter AV replacement, with women and low-gradient AS showing a proportionally more fibrotic phenotype. NH-White women have the highest fibrotic tissue composition, and no differences are evident among men.",

keywords = "aortic valve, aortic valve stenosis, computed tomography angiography, heart valve diseases, racial groups, sex",

author = "Daniel Lorenzatti and Annalisa Filtz and Pamela Pina and Jolien Geers and Jake Gilman and Jonathan Daich and Paul Ippolito and Abdullah Aftab and Schenone, {Aldo L.} and Gongora, {Carlos A.} and Justin Johannesen and Andrea Scotti and Ho, {Edwin C.} and Garcia, {Mario J.} and Azeem Latib and Rodriguez, {Carlos J.} and Berman, {Daniel S.} and Clavel, {Marie Annick} and Philippe Pibarot and Bonow, {Robert O.} and Slomka, {Piotr J.} and Dweck, {Marc R.} and Damini Dey and Leandro Slipczuk",

note = "Publisher Copyright: {\textcopyright} 2025 American Heart Association, Inc.",

year = "2025",

month = jun,

day = "1",

doi = "10.1161/CIRCIMAGING.124.017858",

language = "English (US)",

volume = "18",

journal = "Circulation: Cardiovascular Imaging",

issn = "1941-9651",

publisher = "Lippincott Williams and Wilkins",

number = "6",

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Lorenzatti, D, Filtz, A, Pina, P, Geers, J, Gilman, J, Daich, J, Ippolito, P, Aftab, A, Schenone, AL, Gongora, CA, Johannesen, J, Scotti, A, Ho, EC, Garcia, MJ, Latib, A, Rodriguez, CJ, Berman, DS, Clavel, MA, Pibarot, P, Bonow, RO, Slomka, PJ, Dweck, MR, Dey, D & Slipczuk, L 2025, 'Characterization of Aortic Valve Stenosis by CT Angiography in a Diverse US Cohort', Circulation: Cardiovascular Imaging, vol. 18, no. 6, e017858. https://doi.org/10.1161/CIRCIMAGING.124.017858

TY - JOUR

T1 - Characterization of Aortic Valve Stenosis by CT Angiography in a Diverse US Cohort

AU - Lorenzatti, Daniel

AU - Filtz, Annalisa

AU - Pina, Pamela

AU - Geers, Jolien

AU - Gilman, Jake

AU - Daich, Jonathan

AU - Ippolito, Paul

AU - Aftab, Abdullah

AU - Schenone, Aldo L.

AU - Gongora, Carlos A.

AU - Johannesen, Justin

AU - Scotti, Andrea

AU - Ho, Edwin C.

AU - Garcia, Mario J.

AU - Latib, Azeem

AU - Rodriguez, Carlos J.

AU - Berman, Daniel S.

AU - Clavel, Marie Annick

AU - Pibarot, Philippe

AU - Bonow, Robert O.

AU - Slomka, Piotr J.

AU - Dweck, Marc R.

AU - Dey, Damini

AU - Slipczuk, Leandro

PY - 2025/6/1

Y1 - 2025/6/1

N2 - BACKGROUND: Aortic stenosis (AS) involves calcific and fibrotic degeneration of the valve tissue. The only noninvasive method for evaluating both processes is contrast-enhanced computed tomography angiography. We aimed to explore the differences in aortic valve (AV) tissue composition across sex, race/ethnicity, and AS hemodynamic phenotype in US patients referred for transcatheter AV replacement planning. METHODS: We retrospectively analyzed symptomatic patients with AS who underwent computed tomography angiography for transcatheter AV replacement planning between 2015 and 2022. Using semi-automated software, we quantified the AV tissue composition by fibrotic, calcific, and fibro-calcific volumes, and the fibro-calcific ratio (fibrotic/calcific volume) as a measure of valve phenotype. RESULTS: The study included 651 patients (mean age 84 years; 55% women) with 38% non-Hispanic (NH)-White, 27% Hispanic, and 13% NH-Black. Women had lower fibro-calcific (230 versus 293 mm3/cm2; P<0.001) and calcific volumes (85 versus 149 mm3/cm2; P<0.001), and higher fibro-calcific ratio (1.47 versus 0.83; P<0.001). No differences were observed in the fibrotic volumes (P=0.805). NH-White women had higher fibro-calcific (256 mm3/cm2, P=0.002) and fibrotic volumes (145 mm3/cm2; P<0.001), and fibro-calcific ratio (1.57; P=0.01) compared with Hispanic and NH-Black women. No differences were found among men. High-gradient AS had higher fibro-calcific (295 versus 219 mm3/cm2; P<0.001) and calcific volumes (148 versus 88 mm3/cm2; P<0.001), and a lower fibro-calcific ratio (0.90 versus 1.45; P<0.001), although no difference in fibrotic volume (P=0.099) compared with low-gradient AS. CONCLUSIONS: Phenotypic differences in computed tomography angiography valve tissue composition exist in patients with AS referred for transcatheter AV replacement, with women and low-gradient AS showing a proportionally more fibrotic phenotype. NH-White women have the highest fibrotic tissue composition, and no differences are evident among men.

AB - BACKGROUND: Aortic stenosis (AS) involves calcific and fibrotic degeneration of the valve tissue. The only noninvasive method for evaluating both processes is contrast-enhanced computed tomography angiography. We aimed to explore the differences in aortic valve (AV) tissue composition across sex, race/ethnicity, and AS hemodynamic phenotype in US patients referred for transcatheter AV replacement planning. METHODS: We retrospectively analyzed symptomatic patients with AS who underwent computed tomography angiography for transcatheter AV replacement planning between 2015 and 2022. Using semi-automated software, we quantified the AV tissue composition by fibrotic, calcific, and fibro-calcific volumes, and the fibro-calcific ratio (fibrotic/calcific volume) as a measure of valve phenotype. RESULTS: The study included 651 patients (mean age 84 years; 55% women) with 38% non-Hispanic (NH)-White, 27% Hispanic, and 13% NH-Black. Women had lower fibro-calcific (230 versus 293 mm3/cm2; P<0.001) and calcific volumes (85 versus 149 mm3/cm2; P<0.001), and higher fibro-calcific ratio (1.47 versus 0.83; P<0.001). No differences were observed in the fibrotic volumes (P=0.805). NH-White women had higher fibro-calcific (256 mm3/cm2, P=0.002) and fibrotic volumes (145 mm3/cm2; P<0.001), and fibro-calcific ratio (1.57; P=0.01) compared with Hispanic and NH-Black women. No differences were found among men. High-gradient AS had higher fibro-calcific (295 versus 219 mm3/cm2; P<0.001) and calcific volumes (148 versus 88 mm3/cm2; P<0.001), and a lower fibro-calcific ratio (0.90 versus 1.45; P<0.001), although no difference in fibrotic volume (P=0.099) compared with low-gradient AS. CONCLUSIONS: Phenotypic differences in computed tomography angiography valve tissue composition exist in patients with AS referred for transcatheter AV replacement, with women and low-gradient AS showing a proportionally more fibrotic phenotype. NH-White women have the highest fibrotic tissue composition, and no differences are evident among men.

KW - aortic valve

KW - aortic valve stenosis

KW - computed tomography angiography

KW - heart valve diseases

KW - racial groups

KW - sex

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Characterization of Aortic Valve Stenosis by CT Angiography in a Diverse US Cohort

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