Association between aortic valve calcification measured on non-contrast computed tomography and aortic valve stenosis in the general population

BackgroundAortic valve calcification (AVC) measured on non-contrast computed tomography (CT) has shown correlation to severity of aortic valve stenosis (AS) and mortality in patients with known AS. The aim of this study was to determine the association of CT verified AVC and subclinical AS in a general population undergoing CT.MethodsCT scans from 566 randomly selected male participants (age 65–74) in the Danish cardiovascular screening study (DANCAVAS) were analyzed for AVC. All participants with a moderately or severely increased AVC score (≥300 arbitrary units (AU)) and a matched control group were invited for a supplementary echocardiography. AS was graded by indexed aortic valve area (AVAi) on echocardiography as moderate 0.6–0.85 cm2/m2 and severe < 0.6 cm2/m2, respectively. ROC- and regression analyses were performed.ResultsDue to prior valve surgery, and artifacts from ICD leads 16 individuals were excluded from the AVC scoring. Moderate or severe increased AVC was observed in 10.7% (95% CI: 8.4–13.7). Echocardiography was performed in 101 individuals; 32.7% (95% CI: 21.8 to 46.0) with moderate or high AVC score had moderate or severe AS, while none with no or low AVC. A ROC analysis defined an AVC score ≥588 AU to be suggestive of moderate or severe AS (AUC 0.89 ± 0.04, sensitivity 83% and specificity 87%). In the univariate analyses, AVC was the only variable significantly associated with AS.ConclusionsThis study indicates an association between CT verified AVC and subclinical AS.

Graphical abstractIn patients with recognized aortic stenosis, aortic valve calcification score is of significant importance, while the value of aortic valve calcification is unclarified in the general population. In this study we found increased aortic valve calcification in one of ten apparently healthy, randomly selected males, and subclinical aortic stenosis was observed in 1/3 of these males. This study indicates a highly significant association between aortic valve calcification and subclinical aortic stenosis in the general population.