Very severe aortic valve stenosis: Diagnostic value of computed tomography aortic valve calcium scoring.

Background: (A) Very severe aortic valve stenosis (VSAS; Vmax ≥ 5 ​m/s, MPG ≥60 ​mmHg) is a critical condition with unfavorable clinical outcomes. Guidelines regard VSAS as one criterion for considering valve replacement in asymptomatic patients. (B) Guidelines recommend the use of aortic valve calcium (AVC) scoring as a parameter to differentiate between moderate and severe aortic valve stenosis (SAS). The aim of our study is to propose AVC thresholds for the discrimination between SAS and VSAS.

Methods: Data of patients from a single center who underwent transcatheter aortic valve implantation (n ​= ​523) were retrospectively analyzed. Patients with concordant AS (n ​= ​430) were divided into SAS (n ​= ​344) and VSAS (n ​= ​86) groups and compared in terms of absolute AVC and indexed AVC (body surface area; aortic valve annulus area).

Results: Mean AVC was significantly higher in men (m) than in women (w), and significantly higher in VSAS than in SAS (m: SAS 3572.0 AU; VSAS 5465.0 AU; w: SAS 2252.5 AU; VSAS 3064.5 AU; all p ​< ​0,001). ROC curve analyses showed AVC to be a predictor of VSAS in both sexes (m: AUC 0.794; p ​< ​0.001; w: AUC 0.725; p ​< ​0.001), with optimal cut-off values of 3706.5 AU (m) and 2374.5 (w). Some indexed AVC had a slightly, but not relevantly, better predictive value.

Conclusion: The proposed AVC thresholds - approximately 3700 AU (m) and 2400 AU (w) - showed significant predictive power to differentiate SAS from VSAS in the study cohort.