PMC10167041_01
Quantification of the volume fraction of calcification per cusp and per valve. (A-F) Photographs and microCT-based 3D renderings of the three cusps for patient N1, diagnosed with NF-LG-SAS (A-C) and patient H5, diagnosed with HG-SAS (D-F). For the 3D renderings, soft tissue is shown in red and calcification in white. Scale bars = 5 mm. (G) Volume fraction of calcification for each cusp (dark blue) and for the entire valve (light blue). Arrows indicate the samples illustrated in (A-F). (H) Bar graph comparing the mean volume fraction of calcification for the NF-LG-SAS and HG-SAS groups. Individual datapoints are given for each cusp (n = 15 and n = 21 per group respectively). (I) Correlation between the volume fraction of calcification and the mean pressure gradient across the aortic valve for all patients (left), NF-LG-SAS patients (center) and HG-SAS patients (right). N, NF-LG-SAS; M, moderate AS; H, HG-SAS, ****: p-value < 0.0001.
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F1
The volume fraction of calcification present in the soft tissues of calcified AV cusps explanted from human patients was computed both per valve and per cusp, based on ex vivo microCT images (Figure 1). They were mainly located on the adherent edges of the cusp, along the attachment to the anulus, while for the most calcified samples, not only the edges of the cusp were calcified, but the midportion of the cusp, between free and adherent edges, was affected as well (Figures 1A-F). It ranged from 9.8% to 50.9%, which demonstrates the wide variation among patients, but also among the three cusps of the same patient (Figure 1G). The volume fraction was significantly lower for the NF-LG-SAS cusps than for the HG-SAS ones (Figure 1H). This correlation was stronger when both NF-LG-SAS and HG-SAS groups were considered compared to each group taken individually (Figure 1I).