What does this research mean for the field?

In patients with low gradient aortic stenosis, CTA-based planimetry (pAVACTA) confirms severe aortic stenosis in 82.7% of cases with low flow and 76.3% of cases with normal flow. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

The aim is to evaluate CTA-planimetry as a fourth marker for aortic valve stenosis severity in cases of low gradient severe aortic stenosis.

February 8, 2026

Planimetry in aortic valve stenosis using computed tomography angiography - application in low gradient stenosis

Resultado clave

CTA planimetry confirmed severe aortic stenosis AVA in 82.7% of low-flow and 76.3% of normal-flow low-gradient AS patients, supporting its use as a 4th severity criterion.

Puntos clave

The aim is to evaluate CTA-planimetry as a fourth marker for aortic valve stenosis severity in cases of low gradient severe aortic stenosis.
Included patients with low gradient aortic stenosis who underwent CTA between 2012-2023.
Evaluated congruence of valve area assessed by transthoracic echocardiography and CTA-planimetry.
Proposed specific cutoff values for CTA-planimetry to aid in diagnosis.
Congruence between conventional echocardiography and CTA-planimetry was high at 82.7% for low flow and 76.3% for normal flow cases.
Only 2.5% of low flow and 6.4% of normal flow cases showed non-congruence in assessments.
Introducing CTA-planimetry into diagnostic protocols may enhance certainty in severity classification.

PICO estructurado

Does CTA-planimetry (pAVACTA) provide congruent severity classification compared to TTE in patients with low gradient aortic stenosis?

Población

254 patients with low gradient severe aortic stenosis (cAVATTE <1.0cm², Vmax <4m/s, ∆Pm <40mmHg) who underwent a pre-TAVI CTA scan between 2012 and 2023, including 81 with low-flow (SVI <35ml/m², LVEF ≥50%) and 173 with normal-flow (SVI ≥35ml/m²).

Intervención

Computed tomography angiography (CTA)-planimetry (pAVACTA) for aortic valve area assessment

Comparador

Transthoracic echocardiography (TTE) calculated valve area (cAVATTE)

Resultado

Congruence of aortic valve area severity classification between cAVATTE and pAVACTAsurrogate

CTA-planimetry confirms severe aortic stenosis in a high percentage of patients with low-gradient AS, suggesting its utility as an additional diagnostic criterion when echocardiography is inconclusive.

Resultado numérico

Tasa de eventos absoluta: 0% vs 0%

Resumen

Abstract Background Aortic valve stenosis (AS) severity as assessed by transthoracic echocardiography (TTE) can remain inconclusive when flow velocity (Vmax), mean pressure gradient (∆Pm), and calculated valve area (cAVA) are non-congruent. In particular, the combination of an cAVA1.0cm², Vmax 4.0 m/s and ∆Pm 40mmHg (low gradient (severe) aortic stenosis (LG(S)AS)) is frequently problematic. We suggest AVA by computed tomography angiography (CTA)-planimetry (pAVACTA) as a 4th severity criteria marker to aid classification. Objectives Defining the role of CTA-planimetry in LG(S)AS through integration of pAVACTA as 4th severity marker into the ESC/JASE flow-Charts for AS severity grading. Methods Patients who presented with a cAVATTE1.0cm², Vmax4m/s and ∆Pm40mmHg to our institution and underwent a pre-TAVI-CTA-scan between 2012 and 2023 were included for analysis. The role of pAVACTA as a 4th severity marker was assessed by testing for AVA severity congruence between cAVATTE and pAVACTA. Based on data from a large cohort of patients with congruent severe AS (cAVATTE1.0cm² 35ml/m², LVEF≥50%) and 173 patients with NFLG-AS (Normal Flow SVI≥35ml/m²). Congruence between cAVATTE and pAVACTA was high in both groups at 82.7% and 76.3%, respectively, with non-congruence low at 2.5% and 6.4%. Conclusion In our cohort, CTA-based planimetry confirms AVA indicative of severe AS in a high percentage of patients with LG-AS irrespective of flow. Adding pAVACTA to the diagnostic work-up as a 4th severity criteria may by useful by adding diagnostic certainty.Proposed ESC Flow Chart Modification

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