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The evaluation of aortic stenosis (AS) severity is routinely performed using echocardiography. Current guidelines recommend integrating data with respect to the peak aortic valve jet velocity, the mean transvalvular gradient and the aortic valve area (AVA) calculated by the continuity equation.1 For the majority of patients this assessment works well. However in a third of subjects there is discrepancy in the results provided by these different measures.2 Most commonly this takes the form of an AVA <1.0 cm2 indicating severe stenosis but a peak velocity <4 m/s and mean gradient (MG) <40 mm Hg consistent with moderate disease. While this can sometimes be explained by a low-flow status this is often not the case.3 What then to do in that common situation?
Major interest now surrounds CT calcium scoring of the valve as an assessment of AS severity in cases where echocardiographic measurements are conflicting.4 This is of particular appeal because calcification is believed to be the predominant process driving AS progression and because it provides a flow-independent assessment of severity.5 Complex categorisation of patients based upon flow status and systolic function is therefore not required.
The last few years have witnessed rapid advances in this field. Aortic valve CT calcium scoring has demonstrated a close association with haemodynamic measures of AS on Doppler echocardiography and offers powerful prediction of future disease progression.2 ,6 Moreover we now have proposed cut-offs for differentiating moderate from severe disease (men 2065 AU, women 1274 AU) that provide powerful prognostic information over and above standard echocardiographic indices.7 However, before CT calcium scoring translates into clinical practice it is imperative that we …
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