Journal Article

21 Optimal thresholds of aortic valve calcium score and CT valve area in patients referred for transcatheter aortic valve implantation

Hothi, Sandeep, Mittal, Tarun, Mirsadraee, Saeed, Sabarwal, Kivraj, Ariff, Ben

2025

Overview

ObjectivesTo identify the optimal threshold values of CT-AVCS (CT-Aortic valve calcium score) and CT-AVA (CT-aortic valve area) for diagnosing severe AS (aortic stenosis) in patients referred for TAVI (Transcatheter Aortic valve Implantation CT) against echocardiographic mean gradient (E-MG).Methods1150 consecutive patients from three centres who underwent TAVI-CT systolic phase ECG-gating were identified. Patients with previous aortic valve surgery or TAVI, aortic, or mitral regurgitation were excluded. Patients with LVEF (left ventricular ejection fraction) ≥ 50% and normal indexed stroke volume (28–48 ml/m2) were selected. CT-AVA was obtained by direct planimetry. ROC curves were used to identify optimal thresholds of AVCS and CT-AVA for predicting stenosis severity against E-MG ≥40 mmHg using a combination of sensitivity and specificity.ResultsA total of 428 patients (54% women) with a mean age of 81 years (±7.5) fulfilled the inclusion criteria (Table 1). Severe AS was present in 239 (56%) by E-MG ≥40 mmHg. In men, the optimal threshold for AVCS and CT-AVA were ≥3046 (AUC 0.78) and ≤0.97 cm2 (AUV 0.69) respectively (Table 2). In women, the thresholds were ≥2034 (AUC 0.79) and ≤0.90 cm2 (AUC, 0.71) respectively. The combined AUC of both parameters was 0.79.ConclusionThis study defines the optimal thresholds for AVCS and CT-AVA for severe stenosis in TAVI patient cohort. The AVCS thresholds are much higher than previously reported.

• Publisher: BMJ Publishing Group LTD