Beyond Echocardiography: the role of aortic valve calcium scoring across aortic stenosis etiologies
E Shirka, O Shurdha, H Gjergo, A Gjika, E Dado, M Lezha, A DibraAbstract
Introduction
Aortic stenosis (AS) is a progressive valvular disease with heterogeneous etiologies, including degenerative, bicuspid, and rheumatic valve disease. Although transthoracic echocardiography is the first-line diagnostic modality, echocardiographic parameters may overlap across etiologies, limiting etiological differentiation. Computed tomography–aortic valve calcium (CT-AVC) scoring provides quantitative assessment of calcific burden and may offer additional diagnostic insights beyond hemodynamic evaluation.
Purpose
To assess differences in aortic valve calcium burden and its anatomical distribution among different etiologies of aortic stenosis and to evaluate the complementary diagnostic value of CT-AVC compared with echocardiographic parameters.
Methods
A total of 150 patients with aortic stenosis were included and classified according to etiology as degenerative, bicuspid, or rheumatic. All patients underwent comprehensive transthoracic echocardiography and non-contrast cardiac CT for AVC assessment. Echocardiographic parameters included peak aortic jet velocity (Vmax), mean transaortic gradient (PGmean), and left ventricular ejection fraction (LVEF). CT-AVC was quantified using the Agatston method, and calcium distribution was analyzed at the aortic valve annulus, cusps and commissures. Statistical significance was defined as p < 0.05.
Results
Of the study population, 76.7% had degenerative AS, 8.0% bicuspid AS, and 15.3% rheumatic AS. Female patients represented 54.7% of the cohort. Echocardiographic severity parameters did not differ significantly among etiologies, with comparable Vmax (p=0.310) and mean gradients (p=0.398). Preserved LVEF (>50%) was observed across all groups (p=0.633). Median total AVC score was similar among groups (p=0.889). However, calcification of the aortic valve annulus and commissures was significantly more frequent in degenerative and rheumatic AS compared with bicuspid AS (annulus p=0.0097; commissures p=0.0031).
Conclusion
Despite similar echocardiographic severity across etiologies, CT-derived aortic valve calcium scoring reveals distinct patterns of calcification distribution. CT-AVC provides incremental diagnostic value beyond echocardiography for etiological characterization of aortic stenosis.Echocardiographic parametersFor image description, please refer to the figure legend and surrounding text.Calcium distributionFor image description, please refer to the figure legend and surrounding text.