CT-based aortic valve calcium scoring showed high diagnostic accuracy for identifying severe aortic stenosis (AUC = 0.86), with excellent discrimination in bicuspid valves (AUC = 0.94).
Observational (n=150)
Does CT-AVC scoring accurately identify severe aortic stenosis compared to echocardiography across different etiologies?
CT-AVC scoring provides strong diagnostic accuracy for identifying severe aortic stenosis across different etiologies, including bicuspid valves, correlating well with echocardiographic hemodynamics.
Effect estimate: AUC 0.86
Abstract Introduction Aortic stenosis is a progressive valvular disease in which the extent of valve calcification strongly correlates with disease severity. Computed tomography–based aortic valve calcium (CT-AVC) scoring provides a reproducible and flow-independent method for assessing stenosis. Despite its inclusion in recent ESC guidelines, its application in daily clinical practice remains limited in aortic stenosis of various etiologies. Purpose We aimed to evaluate the diagnostic and clinical utility of CT-AVC in a real-world cohort of patients with aortic stenosis of different etiologies. Methods We retrospectively analyzed 150 consecutive AS patients who underwent echocardiography and non-contrast CT. Severe AS was defined by ESC criteria: Vmax ≥ 4.0 m/s or PGmean ≥ 40 mmHg (no AVA). CT-AVC (Agatston units) was quantified as CaS total; etiologies were classified as degenerative (n=115), bicuspid (n=12), and rheumatic (n=23). We assessed correlations (CaS vs PGmean/Vmax) and ROC performance of CaS for severe AS. Results Severe AS was present in 62/150 (41%). Mean aortic valve calcium score differed significantly by etiology, with degenerative AS showing 2573.9 ± 2184.5 AU, bicuspid AS 2197.2 ± 1819.6 AU, and rheumatic AS 2976.2 ± 2505.7 AU (Table 1). Calcium burden correlated strongly with echocardiographic markers of severity, including mean gradient (r = 0.64) and peak velocity (r = 0.63). Diagnostic performance of CT-AVC for identifying severe AS was high overall (AUC = 0.86), with excellent discrimination in bicuspid valves (AUC = 0.94) (Table 2). Conclusion In real-world practice, CT-AVC shows strong diagnostic accuracy for severe AS by ESC hemodynamic criteria and correlates closely with echocardiographic gradients. Performance remains high across etiologies, with excellent discrimination in bicuspid disease. Integrating CT-AVC can resolve discordant cases and refine decision-making for intervention.CaS Total by EtiologyFor image description, please refer to the figure legend and surrounding text. ROC Analysis for Severe ASFor image description, please refer to the figure legend and surrounding text.
Shirka et al. (Mon,) conducted a observational in Aortic stenosis (n=150). Computed tomography-based aortic valve calcium (CT-AVC) scoring was evaluated on Diagnostic performance for identifying severe aortic stenosis (AUC 0.86). CT-based aortic valve calcium scoring showed high diagnostic accuracy for identifying severe aortic stenosis (AUC = 0.86), with excellent discrimination in bicuspid valves (AUC = 0.94).
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