Real-world experience with computed tomography calcium scoring in aortic stenosis: a 200-patients cohort study
E Shirka, O Shurdha, H Gjergo, A Gjika, M Lezha, A DibraAbstract
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 200 consecutive AS patients who underwent transthoracic echocardiography and non-contrast cardiac CT. Severe AS was defined by ESC hemodynamic criteria (Vmax ≥ 4.0 m/s and/or mean gradient ≥ 40 mmHg). CT-AVC was quantified as total aortic valve calcium score (CaS total in Agatston units). Etiology was classified as degenerative, bicuspid, or rheumatic. Correlations between CaS total and echocardiographic markers were assessed. Diagnostic performance was evaluated using ROC analysis.
Results
Severe AS was present in 77/200 patients (38.5%). The distribution according to etiology was degenerative 154 (77.0%), bicuspid 16 (8.0%), and rheumatic 30 (15.0%). Mean CaS total differed across etiologies as shown in Table 1. CaS total correlated strongly with mean gradient (r = 0.612) and peak velocity (r = 0.596), both with a p value < 0.001. ROC analysis demonstrated high diagnostic accuracy for severe AS (AUC 0.852, 95% CI 0.793–0.903) as shown in Table 2. An optimal cut-off of 2469 AU yielded a sensitivity of 80.5% and specificity of 82.1%.
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.CT-AVC Score According to EtiologyFor image description, please refer to the figure legend and surrounding text.Diagnostic Performance of CaS totalFor image description, please refer to the figure legend and surrounding text.