Diagnostic Performance of Cardiac CT and Transthoracic Echocardiography for Detection of Surgically Confirmed Bicuspid Aortic Valve: Effect of Calcium Extent and Valve Subtypes
Purpose This study aimed to compare the diagnostic performance of cardiac CT and transthoracic
echocardiogram (TTE) depending on the degree of valvular calcification and bicuspid aortic valve
(BAV) subtype.
Materials and Methods This retrospective study included 266 consecutive patients (106 with BAV
and 160 with tricuspid aortic valve) who underwent cardiac CT and TTE before aortic valve replacement.
Cardiac CT was used to evaluate the morphology of the aortic valve, and a calcium scoring scan was used to quantify valve calcium. The aortic valves were classified into fused and two-sinus
types. The diagnostic accuracy of cardiac CT and TTE was calculated using a reference standard for
intraoperative inspection.
Results CT demonstrated significantly higher sensitivity, negative predictive value, and accuracy
than TTE in detecting BAV (p < 0.001, p < 0.001, and p = 0.003, respectively). The TTE sensitivity tended
to decrease as valvular calcification increased. The error rate of TTE for CT was 10.9% for the twosinus
type of BAV and 28.3% for the fused type (p = 0.044).
Conclusion Cardiac CT had a higher diagnostic performance in detecting BAV than TTE and may help
diagnose BAV, particularly in patients with severe valvular calcification