Key result
CT-derived aortic valve area outperforms calcium scores with ~0.82 AUC for severe low-gradient AS.
Why the study?
Computed tomography aortic valve calcium scores have not been studied in comparison to invasive aortic valve study for diagnosing low-gradient aortic stenosis.
Does CT-derived aortic valve area provide better diagnostic performance than CT aortic valve calcium scoring for identifying severe low-gradient aortic stenosis compared to invasive assessment?
Observational (n=294)
Blinded reader
No
Does CT-derived aortic valve area provide better diagnostic performance than CT aortic valve calcium scoring for identifying severe low-gradient aortic stenosis compared to invasive assessment?
Answers are grounded in this paper and cite their sources.
CT-derived aortic valve area demonstrates significantly better diagnostic accuracy than current guideline-recommended CT aortic valve calcium scoring for evaluating severe low-gradient aortic stenosis.
Background Practice guidelines recommend the use of computed tomography (CT) aortic valve calcium (AVC) scores for patients with low-gradient aortic stenosis (LG-AS). AVC has not been studied in comparison to invasive aortic valve study (IAVS). Objectives To determine the diagnostic performance of AVC and CT-derived aortic valve area (CT-AVA) compared to IAVS as a reference standard. Methods We included consecutive patients with LG-AS with echocardiography, CT and IAVS performed within 1 year at a single tertiary center. Severe AS was defined by aortic valve area (AVA) ≤1.0 cm 2 measured by IAVS. CT-AVA was retrospectively measured by a blinded reader. CT-AVA and sex-based AVC were compared to AS defined by IAVS. Diagnostic performance was compared using receiver operating characteristic (ROC) curves. AVC and CT-AVA were compared to cardiac events consisting of death, aortic valve replacement and cardiovascular hospitalization. Results Out of 294 patients in the overall cohort, 206 patients with definite AS severity by IAVS were included as the primary diagnostic cohort. Severe AS according to invasive AVA (≤1.0 cm 2 ) was present in 72 patients (35.0%). Sex-based AVC scores had relatively poor diagnostic performance compared to the reference IAVS with AUCs of 0.59 (95% confidence interval [CI] 0.48–0.70) and 0.58 (95% CI 0.45–0.71) for men and women, respectively. CT-AVA had better diagnostic performance with an AUC of 0.82 (95% CI 0.77–0.87). Conclusions In our study population, CT-AVA had significantly better diagnostic performance than AVC compared to the reference standard, IAVS.
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Cecco et al. (2026) conducted an observational in Low-gradient aortic stenosis (n=294). Computed tomography-derived aortic valve area (CT-AVA) and aortic valve calcium (AVC) scores vs. Invasive aortic valve study (IAVS) was evaluated on Diagnostic performance for severe AS defined by invasive AVA (≤1.0 cm2) (AUC 0.82 for CT-AVA, 95% CI 0.77-0.87). CT-derived aortic valve area demonstrated significantly better diagnostic performance (AUC 0.82; 95% CI 0.77-0.87) than aortic valve calcium scores for identifying severe low-gradient aortic stenosis.
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