The Role of CT in Assessing the Degree of Aortic Valve Calcification and the Severity of Aortic Valve Stenosis

Objective: To evaluate the role of computed tomography in determining the degree of calcification and the severity of aortic valve stenosis.

Material and methods: In total, 118 patients with an indication for transcatheter aortic valve implantation, in accordance with clinical guidelines, were enrolled. All patients provided written informed consent to participate in the study. They were divided into 4 groups, depending on complete (concordant group) or partial (non-concordant group) agreement of aortic stenosis severity parameters based on echocardiography data. All patients underwent preoperative non-contrast cardiac CT.

Results: A positive correlation was found between the calcium score and peak transvalvular flow velocity as well as the mean systolic pressure gradient across the aortic valve: increasing calcium score was associated with higher peak velocity and mean gradient (r = 0.3465 and r = 0.3242; p = 0.0003 and p = 0.0001, respectively). It was also demonstrated that an increase in the calcium score was associated with a reduction in the effective orifice area of the aortic valve and the indexed aortic valve area (r = −0.2446 and r = −0.2679; p = 0.0076 and p = 0.0034, respectively). Statistically significant differences in calcium score were observed between groups with severe aortic stenosis and those with low-gradient stenosis (p = 0.0535), as well as moderate aortic stenosis (p = 0.0231). Discussion: The aortic valve calcium score values differ substantially from widely accepted threshold values. The identification of optimal threshold levels for grading the severity of aortic valve calcification remains a pressing issue.

Conclusion: Computed tomography enables accurate assessment of aortic valve stenosis severity, including cases of low-gradient stenosis or indexed aortic valve area values that do not correspond to severe disease.

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