Association Between AI-derived Thoracic Calcium Volume and Aortic Valve Calcification Quantified by Agatston Scoring

Background/Aim: Aortic valve calcification is a key determinant of aortic stenosis severity. Whether AI-derived thoracic aortic calcium volume reflects valvular calcification remains unclear. This study examined the association between aortic valve calcification quantified using Agatston, volume and mass scores, and total aortic calcium volume measured with an automated AI tool. Patients and Methods: This retrospective single-center study included 32 patients undergoing computed tomography (CT) for transcatheter aortic valve implantation planning. Aortic valve calcification was quantified on noncontrast CT using Agatston, volume and mass scores. Total aortic calcium volume was derived from contrast-enhanced CT using the AI-Rad Companion Chest CT. Correlation analyses and simple linear regression assessed associations between aortic and valvular calcification metrics. Results: Mean total aortic calcium volume was 4.38 ml. Mean aortic valve Agatston score was 3307 units and mean valve calcium volume was 2727 mm3. Correlation between total aortic calcium and aortic valve Agatston score was weak and nonsignificant (Pearson r=0.213, p=0.259). Correlation with valve calcium volume was similarly weak (Pearson r=0.219, p=0.244). Regression models showed minimal explained variance (R2≈4-5 percent), and slopes were not statistically significant. No clinically relevant association between thoracic aortic calcium burden and aortic valve calcification was identified. Conclusion: AI-derived thoracic aortic calcium volume did not correlate with aortic valve calcification. Valvular calcification appears to progress independently of thoracic aortic wall calcification. Automated aortic calcium measurements cannot substitute for direct quantification of aortic valve calcification in preprocedural assessment.