title: Association between aortic valve calcification measured on non-contrast computed tomography and aortic valve stenosis in the general population.
abstract: BACKGROUND
  Aortic valve calcification (AVC) measured on non-contrast computed tomography (CT) has shown correlation to severity of aortic valve stenosis (AS) and mortality in patients with known AS. The aim of this study was to determine the association of CT verified AVC and subclinical AS in a general population undergoing CT.
  
  
  METHODS
  CT scans from 566 randomly selected male participants (age 65-74) in the Danish cardiovascular screening study (DANCAVAS) were analyzed for AVC. All participants with a moderately or severely increased AVC score (≥300 arbitrary units (AU)) and a matched control group were invited for a supplementary echocardiography. AS was graded by indexed aortic valve area (AVAi) on echocardiography as moderate 0.6-0.85 cm(2)/m(2) and severe < 0.6 cm(2)/m(2), respectively. ROC- and regression analyses were performed.
  
  
  RESULTS
  Due to prior valve surgery, and artifacts from ICD leads 16 individuals were excluded from the AVC scoring. Moderate or severe increased AVC was observed in 10.7% (95% CI: 8.4-13.7). Echocardiography was performed in 101 individuals; 32.7% (95% CI: 21.8 to 46.0) with moderate or high AVC score had moderate or severe AS, while none with no or low AVC. A ROC analysis defined an AVC score ≥588 AU to be suggestive of moderate or severe AS (AUC 0.89 ± 0.04, sensitivity 83% and specificity 87%). In the univariate analyses, AVC was the only variable significantly associated with AS.
  
  
  CONCLUSIONS
  This study indicates an association between CT verified AVC and subclinical AS.
authors.affiliation: Department of Cardiology, Odense University Hospital, Denmark.
authors.forename: Niels Herluf
authors.initials: NH
authors.lastname: Paulsen
authors.affiliation: Department of Cardiology, Odense University Hospital, Denmark.
authors.forename: Bjarke Bønløkke
authors.initials: BB
authors.lastname: Carlsen
authors.affiliation: Department of Cardiology, Odense University Hospital, Denmark.
authors.forename: Jordi Sanchez
authors.initials: JS
authors.lastname: Dahl
authors.affiliation: Department of Cardiology, Odense University Hospital, Denmark.
authors.forename: Rasmus
authors.initials: R
authors.lastname: Carter-Storch
authors.affiliation: Department of Cardiology, Odense University Hospital, Denmark.
authors.forename: Nicolaj Lyhne
authors.initials: NL
authors.lastname: Christensen
authors.affiliation: Department of Cardiology, Odense University Hospital, Denmark.
authors.forename: Lida
authors.initials: L
authors.lastname: Khurrami
authors.affiliation: Department of Cardiology, Odense University Hospital, Denmark; Cardiovascular Centre of Excellence (CAVAC), Denmark.
authors.forename: Jacob Eifer
authors.initials: JE
authors.lastname: Møller
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Denmark; Cardiovascular Centre of Excellence (CAVAC), Denmark; Elitary Research Centre of Individualised Medicine in Arterial Disease (CIMA), Denmark.
authors.forename: Jes Sandal
authors.initials: JS
authors.lastname: Lindholt
authors.affiliation: Department of Cardiology, Odense University Hospital, Denmark; Cardiovascular Centre of Excellence (CAVAC), Denmark; Elitary Research Centre of Individualised Medicine in Arterial Disease (CIMA), Denmark. Electronic address: axel.diederichsen@rsyd.dk.
authors.forename: Axel Cosmus Pyndt
authors.initials: AC
authors.lastname: Diederichsen
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D019540:Area Under Curve; D058070:Asymptomatic Diseases; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D016022:Case-Control Studies; D003718:Denmark / Q000453:epidemiology; D015150:Echocardiography, Doppler; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D015995:Prevalence; D012372:ROC Curve; D012720:Severity of Illness Index
keywords: Aortic stenosis; Aortic valve calcification; Echocardiography; Epidemiology; Non-contrast computed tomography