Preliminary Experience in Quantifying Aortic Valve Calcification Using ECG-Gated Multislice Spiral Computed Tomography: Correlation with Hemodynamic Severity of Aortic Stenosis and Evolution to Modern Clinical Applications

Abstract: Objective: Degenerative calcific aortic stenosis (AS) is the most prevalent valvular heart disease in the elderly population. Earlier studies using electron-beam computed tomography (EBCT) demonstrated high reproducibility in quantifying aortic valve calcification (AVC). This preliminary investigation aimed to evaluate the feasibility of retrospectively ECG-gated multislice spiral computed tomography (MSCT) — an emerging technology at the time — for assessing AVC, and to correlate the degree of calcification with invasive hemodynamic parameters of AS severity obtained via cardiac catheterization, laying the groundwork for non-invasive evaluation. Methods: In this prospective study, 41 consecutive patients (18 men; mean age 71 ± 8 years) with varying degrees of AS underwent ECG-gated 4-detector row MSCT (retrospective gating) and subsequent invasive cardiac catheterization within a short interval. AVC was quantified using three established scoring methods: the Agatston score (adapted for the aortic valve), calcium mass score, and volumetric score. AS severity was graded hemodynamically by aortic valve area (AVA), peak-to-peak gradient, and mean transvalvular gradient from catheterization data. Correlations between AVC scores and hemodynamic parameters were analyzed. Results: Patients with severe AS (n=29) exhibited significantly higher AVC scores compared to those with moderate (n=7) or mild (n=5) AS (p