Risk Stratification of Patients With Moderate Aortic Stenosis Using Aortic Valve Calcium

ObjectivesTo evaluate whether aortic valve calcium (AVC) scoring by cardiac CT can enhance risk stratification and identify high-risk patients among those with moderate aortic stenosis (AS). BackgroundModerate AS is traditionally considered benign, yet emerging evidence suggests a subset may experience adverse outcomes similar to those with severe AS. AVC scoring has been validated for diagnosing severe AS but its prognostic value in moderate AS remains unclear. MethodsA retrospective cohort study of 606 patients with moderate aortic stenosis (MAS) for whom aortic valve calcium (AVC) assessment was recommended on echocardiogram reports. Patients were categorized into two groups: those who underwent AVC (n=159) and those who did not (n=447). Primary outcomes included aortic valve replacement (AVR) and all-cause mortality. Secondary outcomes included time to severe AS diagnosis and time to AVR. ResultsA significantly higher proportion of patients in the CT cohort reached a diagnosis of severe AS (28.8% vs. 19.9%, p=0.037) and underwent valve intervention (32.6% vs. 14.1%, p<0.001) compared to the no-CT cohort. Patients underwent valve intervention mostly at the severe AS stage. All-cause mortality was markedly lower in the CT cohort (7.6% vs. 24.9%, p<0.001); difference being driven by excess non-cardiovascular mortality in the no-CT cohort (61.0% vs. 7.9%, p<0.001). Patients with severe AVC (males AVC >2000 AU and females >1200 AU) were more likely to undergo valve intervention compared with non-severe AVC (HR 2.60, 95% CI 1.42-4.74, p=0.002). Patients in the CT cohort were more likely to undergo valve intervention (HR 3.17, CI 2.04-4.91, p<0.001), and had a significantly lower all-cause mortality (HR 0.32, CI 0.16-0.61, p=0.001) compared to the no-CT cohort. ConclusionA practice algorithm incorporating AVC for risk stratification of MAS patients can lead to better outcomes. Role of AVC based decision-making in patients with MAS needs further study in a randomized trial.