PhD Scientific Days 2025

Poster Session II. - U: Cardiovascular Medicine and Research

Low Aortic Valve Calcium Score in Low-gradient Aortic Stenosis: Prognostic and Therapeutic Implications

Name of the presenter

Juhász Dénes

Institute/workplace of the presenter

Heart and Vascular Center, Semmelweis University

Authors

Dénes Juhász¹, Milán Vecsey-Nagy¹, Ádám Jermendy¹, Bálint Szilveszter¹, Borbála Vattay¹, Melinda Boussoussou¹, Pál Maurovich-Horvát², Béla Merkely¹, Astrid Apor¹, Edit Dósa¹, Anikó Ilona Nagy¹

1: Heart and Vascular Center, Semmelweis University
2: Medical Imaging Centre, Semmelweis University

Text of the abstract

Aims: Low-gradient (LG) aortic stenosis (AS) poses a diagnostic challenge. Aortic valve calcium score (AVCS) assessment has emerged as a complementary diagnostic method when echocardiography provides discordant results. However, the diagnostic and prognostic values of AVCS in LGAS have not been thoroughly studied. Our aims in this study were to investigate the prognostic importance of AVCS in LGAS and to assess whether symptomatic patients with LGAS and low AVCS may benefit from aortic valve intervention (AVI).
Methods: A total of 327 symptomatic patients (78.5 ± 7.3 years, 51% women) with severe AS defined by the aortic valve area who underwent computed tomography for transcatheter aortic valve intervention (TAVI) planning were enrolled. AVCS was measured. AVCS < 2000AU in men and < 1200 AU in women was considered a low AVCS.
Results: A total of 243 patients had high gradient (HG) and 84 had LGAS. A low AVCS was present in 25 (10%) patients with HG and 34 (40%) with LGAS. Over a median follow-up period of 4.9 years, 194 deaths occurred. In multivariate analysis, AVCS was a significant independent predictor of all cause mortality among patients with HGAS [adjusted hazard ratio (aHR): 2.317; CI: 1.104–4.861; P = 0.026] but not among those with LGAS (aHR: 0.848; CI: 0.434–1.658; P = 0.630). After propensity score matching between patients who underwent AVI and those who were medically treated, AVI (94% TAVI) was a significant and independent predictor of survival among LGAS patients with a low AVCS even after adjustment for clinical variables (aHR: 0.102, CI: 0.028–0.369; P < 0.001).
Conclusion: The prevalence of a low AVCS is much higher in patients with LGAS than in those with HGAS. In patients with symptomatic severe LGAS, a low AVCS does not entail a better prognosis. AVI is equally beneficial in LGAS patients with a high or low AVCS, similarly to those with HGAS.
Funding: This study was funded by the K-146732 OTKA grant of the Hungarian National Research Development and Innovation Office.