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CT Calcium Score in Low-flow AS — EECC MCQ

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HardValvular Heart DiseaseCT Calcium Score in Low-flow ASEECC

A 60-year-old man with suspected severe AS has a low-flow, low-gradient pattern on echo (AVA 0.9 cm², mean gradient 22 mmHg, LVEF 55%, SVi 30 mL/m²). He is normotensive. What additional investigation helps confirm true severe AS?

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Correct answer: A — CT aortic valve calcium scoring — an aortic valve calcium score >2,000 AU in men (>1,200 AU in women) confirms severe AS in low-flow, low-gradient scenarios

Paradoxical low-flow, low-gradient severe AS (preserved LVEF but low stroke volume index <35 mL/m²) is diagnostically challenging. The 2025 ESC VHD Guidelines recommend CT aortic valve calcium scoring as a key adjunctive test: sex-specific thresholds (>2,000 AU men, >1,200 AU women for very likely severe AS; 1,200-2,000 AU men, 800-1,200 AU women for likely severe) help confirm severity when echocardiographic data are discordant. This differs from the classical low-flow, low-gradient pattern (with reduced LVEF) where dobutamine stress echo is used to assess contractile reserve. CT calcium scoring is objective, reproducible, and flow-independent.

Reference: ESC/EACTS (2025): Guidelines for the Management of Valvular Heart Disease