Key result
CT-derived aortic valve area correlates strongly with echocardiography and predicts adverse clinical outcomes.
Why the study?
Accurate assessment of aortic valve area is essential for managing aortic stenosis, and cardiac CT direct anatomical planimetry may provide complementary information to standard transthoracic echocardiography.
Does cardiac computed tomography provide comparable aortic valve area measurements and prognostic information to transthoracic echocardiography in adults with moderate to severe aortic stenosis?
Cohort (n=1,857)
Single-blind
No
Does cardiac computed tomography provide comparable aortic valve area measurements and prognostic information to transthoracic echocardiography in adults with moderate to severe aortic stenosis?
Effect estimate: r = 0.82 (95% CI 0.76-0.85)
p-value: p=<0.001
Cardiac CT provides highly correlated and complementary aortic valve area measurements compared to echocardiography, with slightly better prognostic discrimination for adverse clinical outcomes in patients with aortic stenosis.
Background: Accurate assessment of aortic valve area (AVA) is essential for determining the severity of aortic stenosis (AS) and guiding clinical management. Transthoracic echocardiography (TTE) is the standard first-line imaging modality, while cardiac computed tomography (CT) provides direct anatomical planimetry and may offer complementary information in selected patients. Objective: To evaluate the correlation and agreement between CT-derived and TTE-derived AVA measurements and to examine their association with clinical outcomes in patients with AS. Methods: This single-center retrospective cohort study included 1,857 consecutive adults with moderate to severe AS who underwent both TTE and cardiac CT at the Rawalpindi Institute of Cardiology between January 2023 and July 2025. Correlation between modalities was assessed using Pearson’s coefficient, while agreement was evaluated with Bland–Altman analysis. Associations between AVA thresholds (≤1.0 cm² vs >1.0 cm²) and adverse clinical outcomes were analyzed using logistic regression and receiver operating characteristic (ROC) analysis. Results: The mean AVA measured by TTE was 0.84 ± 0.19cm² and by CT was 0.87 ± 0.21 cm². A strong correlation was observed between the two modalities (r = 0.82, p < 0.001), with acceptable agreement on Bland–Altman analysis. Patients with AVA ≤ 1.0 cm² had significantly higher rates of adverse clinical outcomes compared with those with larger valve areas. Conclusion: CT-derived AVA demonstrates strong agreement with TTE and provides complementary information for severity assessment and risk stratification in patients with aortic stenosis. Integrating CT with conventional echocardiography may improve clinical evaluation, particularly in cases with discordant or borderline findings.
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Sultan et al. (2026) conducted a cohort in Moderate to severe aortic stenosis (n=1,857). Cardiac computed tomography (CT) vs. Transthoracic echocardiography (TTE) was evaluated on Correlation between CT-derived and echocardiography-derived aortic valve area measurements (r = 0.82, 95% CI 0.76-0.85, p=<0.001). Cardiac computed tomography-derived aortic valve area demonstrated a strong correlation with transthoracic echocardiography (r = 0.82) and effectively discriminated patients at risk for adverse clinical outcomes.
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