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Letters to the Editor |
* Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang Province, China
e-mail: zezhou_song{at}126.com
Department of Internal Medicine, Hangzhou 3rd Hospital, Hangzhou, China
We read with great interest the article by Dr Koos and colleagues (1), in the October 2006 issue of Radiology, in which the authors confirmed that aortic valve calcification (AVC) was an incidental finding on 18% of multi–detector row computed tomographic (CT) scans and that the grade of AVC is correlated with the hemodynamic severity of aortic valve disease as determined with echocardiography. The methods and interpretation of the results, however, raise several concerns.
In this study, Dr Koos and colleagues (1) reviewed computer records of all patients who underwent multi–detector row CT of the chest at their institution between July 2001 and August 2004 (n = 1820) and identified 408 patients who had undergone both chest multi–detector row CT and echocardiography. However, the prevalence of AVC at multi–detector row CT among the excluded 1412 patients was not reported, which could affect the precise evaluation of the prevalence of AVC, even in the national population; the severity of AVC further was underestimated.
It is well known that some conditions can facilitate progression of AVC—for example, urinemia, hypertension, diabetes mellitus, hyperlipidemia, or smoking—and that drug therapy can regress the progression of AVC. However, the above-mentioned baseline parameters and the condition of drug therapy among the included 402 patients were not described in the article by Dr Koos and colleagues (1). In addition, the baseline parameters of patients at least 65 years old and the patients younger than 65 years, men and women, were not also described. The above-mentioned factors that were not described could also affect the precise evaluation of the prevalence of AVC, even in the national population; the severity of AVC was further underestimated, and the authenticity of this study was degraded.
In conclusion, the prevalence of AVC in the wider population should be confirmed, so as to further show the significance of AVC in predictors of prognosis in these patients.
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, and
Andreas Horst Mahnken, MD
* Department of Cardiology, University Hospital Aachen, University of Technology Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
e-mail: rkoos{at}ukaachen.de
Department of Diagnostic Radiology, University Hospital Aachen, University of Technology Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
We read with great interest the commentary of Drs Song and Ma concerning our study, "Prevalence and Clinical Importance of Aortic Valve Calcifications Detected Incidentally on CT Scans: Comparisons with Echocardiography" (1).
In this study, we retrospectively analyzed only those patients, concerning both the prevalence and quantity of AVC, who underwent chest CT and echocardiography (n = 408) because one major aim of the study was the comparison of AVC at chest CT and echocardiography. We admit that this method might have influenced the precise evaluation of the prevalence of AVC. However, our results are comparable to those of a large study of 1812 patients who underwent electron-beam tomography for coronary artery calcification (2). In that study, 13% of the patients showed incidentally detected AVC.
In addition, we compared the grade of AVC on CT scans and the precise echocardiographically determined mean and peak transvalvular instantaneous gradient in patients with aortic stenosis. Of course, it is well known that cardiovascular risk factors or renal insufficiency may facilitate the progression of AVC. However, in our retrospective study the progression of AVC and predictors of prognosis were not evaluated. In addition, indications for chest CT were mainly evaluation of thoracic and extrathoracic malignant tumors and pulmonary infection. Thus, there is no reason to assume that the prevalence of, for example, diabetes or renal failure, may be higher than that in a control cohort.
The major finding of our study is that patients with moderate or severe AVC incidentally detected on chest CT scans frequently have aortic stenosis and may benefit from functional assessment with echocardiography. We aimed to demonstrate that there is also a correlation on ungated chest CT scans between the grade of AVC and the echocardiographically determined severity of aortic valve stenosis. To evaluate factors influencing the progression and prognosis in patients with AVC, as discussed by Drs Song and Ma, further prospective studies are needed.
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