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Patients undergoing routine multi-sliced computed tomography (MSCT) for procedural planning were enrolled. MSCT data were transferred to a dedicated workstation for evaluation (3mensio Structural Heart\u2122, Pie Medical Imaging BV, Maastricht, The Netherlands) and analyzed. Participants were separated into asymmetrical (AC) and symmetrical (SC) leaflet calcification and potential predictors for calcification distribution were identified with univariate and multivariate regression analysis. 567 Participants with severe tricuspid AS were divided into asymmetrical (AC, n\u2009=\u2009443; 78.1%) and symmetrical (SC, n\u2009=\u2009124; 21.9%) AVC. In AC, the non-coronary cusp was the most calcified cusp (n\u2009=\u2009238; 57.7%). SC is more common in females (AC\/SC: 49.2% vs. 67.7%; p\u2009&lt;\u20090.0001). AVC was more severe in patients with AC, who also have larger aortic root dimensions. Multivariate analysis depicted, inter alia, left ventricular outflow tract (LVOT) calcification\u2009&lt;\u200925 Agatston units (OR 1.81 [1.09\u20133.00], p\u2009=\u20090.021), a mean pressure gradient\u2009&lt;\u200936 mmHg (OR 1.77 [1.03\u20133.05], p\u2009=\u20090.039), and an annulo-apical angle\u2009&gt;\u200967\u00b0 (OR 1.68 [1.00\u20132.80], p\u2009=\u20090.049) as predictors for SC, although with only moderate predictive value. Data from this retrospective analysis indicate that SC occurs more frequently in females. The cumulative leaflet calcification burden is higher in patients with AC, who also present with larger aortic root dimensions. The predictive value for prominent calcification of different aortic valve cusps in AC patients was only low to moderate.<\/jats:p><jats:p><jats:bold>Trial registration number<\/jats:bold>: NCT01805739.<\/jats:p>","DOI":"10.1007\/s10554-021-02248-6","type":"journal-article","created":{"date-parts":[[2021,4,20]],"date-time":"2021-04-20T10:35:46Z","timestamp":1618914946000},"page":"2791-2799","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Predictors of calcification distribution in severe tricuspid aortic valve stenosis"],"prefix":"10.1007","volume":"37","author":[{"given":"Kerstin","family":"Piayda","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Dannenberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saif","family":"Zako","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Maier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Bosbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amin","family":"Polzin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shazia","family":"Afzal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Jung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf","family":"Westenfeld","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malte","family":"Kelm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Zeus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2744-2154","authenticated-orcid":false,"given":"Verena","family":"Veulemans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,4,20]]},"reference":[{"issue":"9540","key":"2248_CR1","doi-asserted-by":"publisher","first-page":"1005","DOI":"10.1016\/S0140-6736(06)69208-8","volume":"368","author":"VT Nkomo","year":"2006","unstructured":"Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M (2006) Burden of valvular heart diseases: a population-based study. 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All other authors have nothing to disclose with regard to this project.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The study procedures are in accordance with the Declaration of Helsinki, and the Institutional Ethics Committee of the Heinrich-Heine University approved the study protocol (4080). The study is registered at clinical trials (NCT01805739).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"<!--Emphasis Type='Bold' removed-->Ethical approval"}},{"value":"All patients provided written informed consent for use of clinical, procedural, and follow-up data for research and publication.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}