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Computed Tomography Aortic Valve Calcium Scores Across Echocardiographic Phenotypes in Patients Evaluated for Transcatheter Aortic Valve Implantation
Session:
Sessão de Posters 39 - Fenótipos de estenose aórtica, imagem e fisiopatologia
Speaker:
Carolina Ponte Esteves
Congress:
CPC 2026
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.3 Valvular Heart Disease – Diagnostic Methods
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Carolina Esteves; Adriana Vazão; Joana Pereira; Mónica Amado; André Martins; Carolina Gonçalves; Luís Graça Santos; Rita Carvalho; David Durão
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Aptos",sans-serif"><strong>Background:</strong> Computed tomography (CT) aortic valve calcium score (AVCS) is used for severity grading in low-gradient aortic stenosis (AS), yet its distribution across echocardiographic phenotypes in real-world transcatheter aortic valve implantation (TAVI) candidates is incompletely characterised.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Aptos",sans-serif"><strong>Objectives:</strong> To compare AVCS across high-gradient (HG), low-flow low-gradient (LFLG) and normal-flow low-gradient (NFLG) AS phenotypes, and to evaluate European Society of Cardiology (ESC) calcium severity categories within these groups.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Aptos",sans-serif"><strong>Methods:</strong> We retrospectively analysed consecutive patients undergoing pre-TAVI cardiac CT at our centre (June 2022–October 2025). Only patients with a reported AVCS were included. AS phenotypes were defined using standard ESC criteria, including aortic valve area (AVA), mean transvalvular gradient, peak velocity (Vmax) and stroke volume index (SVI). Patients with discordant high-gradient AS (n=3) or without a definable phenotype (n=44) were excluded. AVCS was analysed as a continuous variable and categorised using sex-specific ESC thresholds: unlikely severe (men <1600 AU; women <800 AU), grey zone (men 1600–2000 AU; women 800–1200 AU) and likely severe (men >2000 AU; women >1200 AU).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Aptos",sans-serif"><strong>Results:</strong> Ninety-three patients had both valid AVCS and phenotype classification (HG=77, LFLG=9, NFLG=7). Median (interquartile range [IQR]) AVCS was: HG 2331 (1656–3404) AU, LFLG 1489 (1115–3086) AU and NFLG 2485 (1282–2668) AU. AVCS as a continuous variable did not differ significantly between groups (Kruskal–Wallis p=0.285). However, ESC calcium categories showed distinct patterns: HG and NFLG displayed similarly high proportions of “likely severe” AVCS (83% and 86%, respectively), whereas LFLG was more heterogeneous, with one-third classified as “unlikely severe”. The distribution of ESC calcium categories differed numerically across phenotypes, although the Fisher–Freeman–Halton test did not reach statistical significance (p=0.055).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Aptos",sans-serif"><strong>Conclusions:</strong> Although AVCS did not differ statistically across phenotypes, its distribution revealed clinically relevant differences. NFLG patients demonstrated calcium burdens similar to HG AS, consistent with preserved structural severity despite lower gradients. LFLG patients were more variable, with a subset showing low calcium scores compatible with non-severe disease. These findings support a complementary role for AVCS in the assessment of low-gradient AS in TAVI candidates.</span></span></p>
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