{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T03:11:17Z","timestamp":1793502677812,"version":"4.5.0"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T00:00:00Z","timestamp":1743552000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T00:00:00Z","timestamp":1743552000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Objective<\/jats:title>\n            <jats:p>BSCI\/BSTI guidelines recommend reporting aortic valve calcification (AVC) on all chest CTs regardless of indication. We assessed AVC frequency, severity, and association with aortic stenosis (AS) on echocardiography and its prognostic implications.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Retrospective, single-centre analysis of consecutive chest CTs (January\u2013December 2015) for 200 patients per age group (&lt;\u200940, 40\u201349, 50\u201359, 60\u201369, 70\u201379, 80\u201389, \u2265\u200990) performed for medical, surgical, and oncological indications. CTs were re-reviewed for the presence and graded severity of AVC and coronary artery calcification (CAC). Corresponding echocardiography reports (within 5 years) reviewed for AS. Comorbidities and clinical outcomes were recorded.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>One thousand three hundred seventy-seven patients were included (mean age 64\u2009\u00b1\u200920 years, 55% female). AVC was present in 25% (350\/1377) and was more prevalent in males (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Frequency and severity increased with age (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). 38% (524\/1377) had an echocardiogram (median inter-test interval 4.3 months [IQR 0.4\u201317.5]). Sixteen per cent (29\/178) with AVC had AS of any severity (8% [15\/178] mild; 8% [14\/178] moderate; 0% [0\/178] severe). Sensitivity and specificity for AVC predicting AS were 91% and 70%, respectively. Extrapolating findings, 8% of individuals with AVC and without an echocardiogram may have undiagnosed AS. All-cause mortality occurred in 53% (734\/1377), which AVC predicted independently of CAC and age (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Adjusting for confounders, severe AVC predicted all-cause mortality (HR 1.56 [1.10\u20132.22], <jats:italic>p<\/jats:italic>\u2009=\u20090.013).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>AVC identified AS in 16% of patients. Additionally, severe AVC is an independent predictor of all-cause mortality in multivariable analysis. Validation in a prospective cohort is required to inform clinical practice guidelines.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Key Points<\/jats:title>\n            <jats:p>\n              <jats:bold>\n                <jats:italic>Question<\/jats:italic>\n              <\/jats:bold>\n              <jats:italic>New guidelines recommend reporting AVC on all non-gated chest CTs, the prognostic and clinical relevance of which is uncertain<\/jats:italic>.<\/jats:p>\n            <jats:p>\n              <jats:bold>\n                <jats:italic>Findings<\/jats:italic>\n              <\/jats:bold>\n              <jats:italic>There are associations between visually quantified AVC, AS on echocardiography, and all-cause mortality in an unselected population referred for routine chest CT<\/jats:italic>.<\/jats:p>\n            <jats:p>\n              <jats:bold>\n                <jats:italic>Clinical relevance<\/jats:italic>\n              <\/jats:bold>\n              <jats:italic>These results support the reporting of all severities of AVC, especially severe AVC, as a prognostic marker in all age groups. The clinical implications require further clarification in a prospective cohort<\/jats:italic>.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Graphical Abstract<\/jats:title>\n          <\/jats:sec>","DOI":"10.1007\/s00330-025-11553-w","type":"journal-article","created":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T07:15:42Z","timestamp":1743750942000},"page":"6291-6301","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Visual ordinal grading of aortic valve calcification on routine non-gated chest CT predicts prognosis and alters management"],"prefix":"10.1007","volume":"35","author":[{"given":"Samuel G. S.","family":"Gunning","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Graby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yashesh","family":"Mody","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pia F. P.","family":"Charters","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim A.","family":"Burnett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Murphy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Khavandi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2744-3509","authenticated-orcid":false,"given":"Jonathan C. L.","family":"Rodrigues","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,2]]},"reference":[{"key":"11553_CR1","doi-asserted-by":"publisher","first-page":"1670","DOI":"10.1161\/CIRCULATIONAHA.119.043391","volume":"141","author":"S Yadgir","year":"2020","unstructured":"Yadgir S, Johnson CO, Aboyans V et al (2020) Global, regional, and national burden of calcific aortic valve and degenerative mitral valve diseases, 1990\u20132017. Circulation 141:1670\u20131680","journal-title":"Circulation"},{"key":"11553_CR2","doi-asserted-by":"publisher","first-page":"1231","DOI":"10.1016\/S0195-668X(03)00201-X","volume":"24","author":"B Lung","year":"2003","unstructured":"Lung B, Baron G, Butchart EG et al (2003) A prospective survey of patients with valvular heart disease in Europe: the euro heart survey on valvular heart disease. Eur Heart J 24:1231\u20131243. https:\/\/doi.org\/10.1016\/S0195-668X(03)00201-X","journal-title":"Eur Heart J"},{"key":"11553_CR3","doi-asserted-by":"publisher","first-page":"1906","DOI":"10.1136\/heartjnl-2020-317125","volume":"106","author":"MK Doris","year":"2020","unstructured":"Doris MK, Jenkins W, Robson P et al (2020) Computed tomography aortic valve calcium scoring for the assessment of aortic stenosis progression. Heart 106:1906\u20131913. https:\/\/doi.org\/10.1136\/heartjnl-2020-317125","journal-title":"Heart"},{"key":"11553_CR4","doi-asserted-by":"publisher","first-page":"1018","DOI":"10.1016\/0735-1097(90)90235-H","volume":"15","author":"E Braunwald","year":"1990","unstructured":"Braunwald E (1990) On the natural history of severe aortic stenosis. J Am Coll Cardiol 15:1018\u20131020","journal-title":"J Am Coll Cardiol"},{"key":"11553_CR5","doi-asserted-by":"publisher","first-page":"e001743","DOI":"10.1136\/openhrt-2021-001743","volume":"9","author":"V Pankayatselvan","year":"2022","unstructured":"Pankayatselvan V, Raber I, Playford D et al (2022) Moderate aortic stenosis: Culprit or bystander? Open Heart 9:e001743. https:\/\/doi.org\/10.1136\/openhrt-2021-001743","journal-title":"Open Heart"},{"key":"11553_CR6","doi-asserted-by":"publisher","first-page":"721","DOI":"10.4070\/kcj.2022.0234","volume":"52","author":"S Ito","year":"2022","unstructured":"Ito S, Oh JK (2022) Aortic stenosis: new insights in diagnosis, treatment, and prevention. Korean Circ J 52:721\u2013736","journal-title":"Korean Circ J"},{"key":"11553_CR7","doi-asserted-by":"publisher","first-page":"2067","DOI":"10.1136\/heartjnl-2017-312304","volume":"104","author":"RJ Everett","year":"2018","unstructured":"Everett RJ, Clavel MA, Pibarot P, Dweck MR (2018) Timing of intervention in aortic stenosis: a review of current and future strategies. Heart 104:2067\u20132076. https:\/\/doi.org\/10.1136\/heartjnl-2017-312304","journal-title":"Heart"},{"key":"11553_CR8","unstructured":"ClinicalTrials.gov (2019) The early valve replacement in severe asymptomatic aortic stenosis study (EASY-AS). https:\/\/www.clinicaltrials.gov\/study\/NCT04204915?cond=aortic%20stenosis%20asymptomatic&rank=1. Accessed 29 Sep 2023"},{"key":"11553_CR9","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1016\/j.atherosclerosis.2020.06.019","volume":"307","author":"JL Christensen","year":"2020","unstructured":"Christensen JL, Tan S, Chung HE et al (2020) Aortic valve calcification predicts all-cause mortality independent of coronary calcification and severe stenosis. Atherosclerosis 307:16\u201320. https:\/\/doi.org\/10.1016\/j.atherosclerosis.2020.06.019","journal-title":"Atherosclerosis"},{"key":"11553_CR10","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1161\/01.CIR.0000135469.82545.D0","volume":"110","author":"D Messika-Zeitoun","year":"2004","unstructured":"Messika-Zeitoun D, Aubry MC, Detaint D et al (2004) Evaluation and clinical implications of aortic valve calcification measured by electron-beam computed tomography. Circulation 110:356\u2013362. https:\/\/doi.org\/10.1161\/01.CIR.0000135469.82545.D0","journal-title":"Circulation"},{"key":"11553_CR11","doi-asserted-by":"publisher","first-page":"e3710","DOI":"10.1097\/MD.0000000000003710","volume":"95","author":"HY Lee","year":"2016","unstructured":"Lee HY, Kim SM, Lee KS et al (2016) Quantification of aortic valve calcifications detected during lung cancer-screening CT helps stratify subjects necessitating echocardiography for aortic stenosis diagnosis. Medicine (Baltimore) 95:e3710. https:\/\/doi.org\/10.1097\/MD.0000000000003710","journal-title":"Medicine (Baltimore)"},{"key":"11553_CR12","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1136\/hrt.2010.198853","volume":"97","author":"C Cueff","year":"2011","unstructured":"Cueff C, Serfaty JM, Cimadevilla C et al (2011) Measurement of aortic valve calcification using multislice computed tomography: correlation with haemodynamic severity of aortic stenosis and clinical implication for patients with low ejection fraction. Heart 97:721\u2013726. https:\/\/doi.org\/10.1136\/hrt.2010.198853","journal-title":"Heart"},{"key":"11553_CR13","doi-asserted-by":"publisher","first-page":"2658","DOI":"10.1007\/s00330-019-06614-w","volume":"30","author":"Y Zhu","year":"2020","unstructured":"Zhu Y, Wang Y, Gioia WE et al (2020) Visual scoring of aortic valve calcifications on low-dose CT in lung cancer screening. Eur Radiol 30:2658\u20132668. https:\/\/doi.org\/10.1007\/s00330-019-06614-w","journal-title":"Eur Radiol"},{"key":"11553_CR14","doi-asserted-by":"publisher","first-page":"e007146","DOI":"10.1161\/CIRCIMAGING.117.007146","volume":"11","author":"T Pawade","year":"2018","unstructured":"Pawade T, Clavel M-A, Tribouilloy C et al (2018) Computed tomography aortic valve calcium scoring in patients with aortic stenosis. Circ Cardiovasc Imaging 11:e007146. https:\/\/doi.org\/10.1161\/CIRCIMAGING.117.007146","journal-title":"Circ Cardiovasc Imaging"},{"key":"11553_CR15","doi-asserted-by":"publisher","first-page":"1202","DOI":"10.1016\/j.jacc.2014.05.066","volume":"64","author":"M-A Clavel","year":"2014","unstructured":"Clavel M-A, Pibarot P, Messika-Zeitoun D et al (2014) Impact of aortic valve calcification, as measured by MDCT, on survival in patients with aortic stenosis results of an International Registry Study. J Am Coll Cardiol 64:1202\u20131213","journal-title":"J Am Coll Cardiol"},{"key":"11553_CR16","doi-asserted-by":"crossref","unstructured":"Williams C, Abbas A, Tirr E et al (2020) Reporting incidental coronary, aortic valve and cardiac calcification on non-gated thoracic computed tomography, a consensus statement from the BSCI\/BSCCT and BSTI. Br J Radiol 93:20200894","DOI":"10.1259\/bjr.20200894"},{"key":"11553_CR17","unstructured":"NHS Health Research Authority (2020) Decision tools\u2014Is my study research? https:\/\/www.hra-decisiontools.org.uk\/research\/. Accessed 5 Jul 2023"},{"key":"11553_CR18","doi-asserted-by":"publisher","first-page":"342","DOI":"10.2214\/AJR.04.1366","volume":"186","author":"F Liu","year":"2006","unstructured":"Liu F, Coursey CA, Grahame-Clarke C et al (2006) Aortic valve calcification as an incidental finding at CT of the elderly: severity and location as predictors of aortic stenosis. AJR Am J Roentgenol 186:342\u2013349. https:\/\/doi.org\/10.2214\/AJR.04.1366","journal-title":"AJR Am J Roentgenol"},{"key":"11553_CR19","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1016\/J.CRAD.2023.02.007","volume":"78","author":"J Graby","year":"2023","unstructured":"Graby J, Soto-Hernaez J, Murphy D et al (2023) Coronary artery calcification on routine CT has prognostic and treatment implications for all ages. Clin Radiol 78:412\u2013420. https:\/\/doi.org\/10.1016\/J.CRAD.2023.02.007","journal-title":"Clin Radiol"},{"key":"11553_CR20","doi-asserted-by":"publisher","first-page":"G19","DOI":"10.1530\/ERP-20-0035","volume":"8","author":"L Ring","year":"2021","unstructured":"Ring L, Shah BN, Bhattacharyya S et al (2021) Echocardiographic assessment of aortic stenosis: a practical guideline from the British Society of Echocardiography. Echo Res Pract 8:G19\u2013G59. https:\/\/doi.org\/10.1530\/ERP-20-0035","journal-title":"Echo Res Pract"},{"key":"11553_CR21","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1093\/ehjci\/jew335","volume":"18","author":"H Baumgartner","year":"2017","unstructured":"Baumgartner H, Hung J, Bermejo J et al (2017) Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 18:254\u2013275. https:\/\/doi.org\/10.1093\/ehjci\/jew335","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"11553_CR22","doi-asserted-by":"publisher","first-page":"159","DOI":"10.2307\/2529310","volume":"33","author":"JR Landis","year":"1977","unstructured":"Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159\u2013174","journal-title":"Biometrics"},{"key":"11553_CR23","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1148\/radiol.2411051163","volume":"241","author":"R Koos","year":"2006","unstructured":"Koos R, K\u00fchl HP, M\u00fchlenbruch G et al (2006) Prevalence and clinical importance of aortic valve calcification detected incidentally on CT scans: comparison with echocardiography. Radiology 241:76\u201382. https:\/\/doi.org\/10.1148\/radiol.2411051163","journal-title":"Radiology"},{"key":"11553_CR24","doi-asserted-by":"publisher","first-page":"1748","DOI":"10.1053\/euhj.2000.2586","volume":"22","author":"P Hunold","year":"2001","unstructured":"Hunold P, Schmermund A, Seibel RM, Gr\u00f6nemeyer DH, Erbel R (2001) Prevalence and clinical significance of accidental findings in electron-beam tomographic scans for coronary artery calcification. Eur Heart J 22:1748\u20131758. https:\/\/doi.org\/10.1053\/euhj.2000.2586","journal-title":"Eur Heart J"},{"key":"11553_CR25","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1016\/j.jcct.2015.03.012","volume":"9","author":"GH Tison","year":"2015","unstructured":"Tison GH, Guo M, Blaha MJ et al (2015) Multisite extracoronary calcification indicates increased risk of coronary heart disease and all-cause mortality: the multi-ethnic study of atherosclerosis. J Cardiovasc Comput Tomogr 9:406\u2013414. https:\/\/doi.org\/10.1016\/j.jcct.2015.03.012","journal-title":"J Cardiovasc Comput Tomogr"},{"key":"11553_CR26","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1136\/heartjnl-2018-313269","volume":"105","author":"SM Bradley","year":"2019","unstructured":"Bradley SM, Foag K, Monteagudo K et al (2019) Use of routinely captured echocardiographic data in the diagnosis of severe aortic stenosis. Heart 105:112\u2013116. https:\/\/doi.org\/10.1136\/heartjnl-2018-313269","journal-title":"Heart"},{"key":"11553_CR27","doi-asserted-by":"publisher","unstructured":"Loganath K, Craig NJ, Everett RJ et al (2024) Early intervention in patients with asymptomatic severe aortic stenosis and myocardial fibrosis. JAMA. https:\/\/doi.org\/10.1001\/jama.2024.22730","DOI":"10.1001\/jama.2024.22730"},{"key":"11553_CR28","doi-asserted-by":"publisher","unstructured":"Patel KP, Lin A, Kumar N et al (2023) Influence of cusp morphology and sex on quantitative valve composition in severe aortic stenosis. Eur Heart J Cardiovasc Imaging. https:\/\/doi.org\/10.1093\/ehjci\/jead142","DOI":"10.1093\/ehjci\/jead142"}],"container-title":["European Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-025-11553-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00330-025-11553-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-025-11553-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T10:03:58Z","timestamp":1757498638000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00330-025-11553-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,2]]},"references-count":28,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["11553"],"URL":"https:\/\/doi.org\/10.1007\/s00330-025-11553-w","relation":{},"ISSN":["1432-1084"],"issn-type":[{"value":"1432-1084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,2]]},"assertion":[{"value":"10 September 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 January 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 February 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 April 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The scientific guarantor of this publication is Dr J.C.L.R.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Guarantor"}},{"value":"The authors of this manuscript declare relationships with the following companies: J.C.L.R. reports a relationship with Aidence that includes: speaking and lecture fees. J.C.L.R. reports a relationship with Sanofi that includes: speaking and lecture fees. J.C.L.R. reports a relationship with NHS X that includes: consulting or advisory. J.C.L.R. reports a relationship with Heart and Lung Health that includes: employment. J.C.L.R. reports a relationship with Heart Flow that includes: physicians\u2019 services. J.G. reports a relationship with Sanofi that includes: speaking and lecture fees. S.G.S.G. reports a relationship with Opto Health that includes: consulting or advisory. The remaining authors report no conflicts of interest.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"No complex statistical methods were necessary for this paper.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Written informed consent was not required as per the Health Research Authority\u2019s decision tool.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Institutional Review Board approval was not required as per the Health Research Authority\u2019s decision tool. This retrospective observational study included patients who had previously undergone clinically indicated imaging and was approved as a service evaluation by our institution\u2019s Trust Audit Committee. Preliminary work was presented as an abstract at the 2023 British Cardiovascular Society Conference.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"No study subjects or cohorts have previously been reported.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}