Aortic valve calcification score utility extended to moderate aortic stenosis

This editorial refers to ‘Aortic valve calcification among elderly males from the general population, associated echocardiographic findings and clinical implications’, by L. Khurrami et al., pp. 177--84 Calcification is the prevailing pathophysiology of aortic stenosis,1 which provides the rationale for valvular calcification imaging. The distinction of severe aortic stenosis is crucial to determine the indications for surgical and transcatheter aortic valve replacement.2 Complementing haemodynamic measures on echocardiography with a non-contrast computed tomography aortic valve calcification score (CT-AVC) has been established as part of the integrative approach to diagnose severe aortic stenosis. This is particularly useful in cases of discordant grading, when the reduced opening aortic valve area reaches the criteria for severe aortic stenosis whereas gradients and velocities are low despite preserved ejection fraction. Likewise, in low-flow low-gradient aortic stenosis, CT-AVC is emerging as an alternative to stress echocardiography to distinguish pseudo-severe from true severe aortic stenosis without...