{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T22:49:54Z","timestamp":1794264594479,"version":"4.9.0"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2024,10,29]],"date-time":"2024-10-29T00:00:00Z","timestamp":1730160000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100011019","name":"Hungarian National Research Development and Innovation Office","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100011019","id-type":"DOI","asserted-by":"publisher"}]},{"name":"J\u00e1nos Bolyai Research Scholarship"},{"DOI":"10.13039\/501100003825","name":"Hungarian Academy of Sciences","doi-asserted-by":"publisher","award":["\u00daNKP-23-5"],"award-info":[{"award-number":["\u00daNKP-23-5"]}],"id":[{"id":"10.13039\/501100003825","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003825","name":"Hungarian Academy of Sciences","doi-asserted-by":"publisher","award":["K 146929 OTKA"],"award-info":[{"award-number":["K 146929 OTKA"]}],"id":[{"id":"10.13039\/501100003825","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>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).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>A total of 327 symptomatic patients (78.5 \u00b1 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 &amp;lt; 2000AU in men and &amp;lt; 1200 AU in women was considered a low AVCS. 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\u20134.861; P = 0.026] but not among those with LGAS (aHR: 0.848; CI: 0.434\u20131.658; 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\u20130.369; P &amp;lt; 0.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjci\/jeae276","type":"journal-article","created":{"date-parts":[[2024,10,29]],"date-time":"2024-10-29T13:47:47Z","timestamp":1730209667000},"page":"287-298","source":"Crossref","is-referenced-by-count":7,"title":["Prognostic and therapeutic implications of a low aortic valve calcium score in patients with low-gradient aortic stenosis"],"prefix":"10.1093","volume":"26","author":[{"given":"D","family":"Juh\u00e1sz","sequence":"first","affiliation":[{"name":"Heart and Vascular Centre, Semmelweis University , 68. Varosmajor u, 1122-Budapest ,","place":["Hungary"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9306-289X","authenticated-orcid":false,"given":"M","family":"Vecsey-Nagy","sequence":"additional","affiliation":[{"name":"Heart and Vascular Centre, Semmelweis University , 68. Varosmajor u, 1122-Budapest ,","place":["Hungary"]},{"name":"Department of Radiology and Radiological Science, Medical University of South Carolina , Charleston, SC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c1 L","family":"Jermendy","sequence":"additional","affiliation":[{"name":"Heart and Vascular Centre, Semmelweis University , 68. Varosmajor u, 1122-Budapest ,","place":["Hungary"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B","family":"Szilveszter","sequence":"additional","affiliation":[{"name":"Heart and Vascular Centre, Semmelweis University , 68. Varosmajor u, 1122-Budapest ,","place":["Hungary"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8063-3462","authenticated-orcid":false,"given":"J","family":"Simon","sequence":"additional","affiliation":[{"name":"Department of Radiology and Radiological Science, Medical University of South Carolina , Charleston, SC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B","family":"Vattay","sequence":"additional","affiliation":[{"name":"Heart and Vascular Centre, Semmelweis University , 68. Varosmajor u, 1122-Budapest ,","place":["Hungary"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Boussoussou","sequence":"additional","affiliation":[{"name":"Heart and Vascular Centre, Semmelweis University , 68. Varosmajor u, 1122-Budapest ,","place":["Hungary"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"D\u00e1vid","sequence":"additional","affiliation":[{"name":"Heart and Vascular Centre, Semmelweis University , 68. Varosmajor u, 1122-Budapest ,","place":["Hungary"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Maurovich-Horv\u00e1t","sequence":"additional","affiliation":[{"name":"Medical Imaging Centre, Semmelweis University , Budapest ,","place":["Hungary"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B","family":"Merkely","sequence":"additional","affiliation":[{"name":"Heart and Vascular Centre, Semmelweis University , 68. Varosmajor u, 1122-Budapest ,","place":["Hungary"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Apor","sequence":"additional","affiliation":[{"name":"Heart and Vascular Centre, Semmelweis University , 68. Varosmajor u, 1122-Budapest ,","place":["Hungary"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0861-1247","authenticated-orcid":false,"given":"L","family":"Moln\u00e1r","sequence":"additional","affiliation":[{"name":"Heart and Vascular Centre, Semmelweis University , 68. Varosmajor u, 1122-Budapest ,","place":["Hungary"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E","family":"D\u00f3sa","sequence":"additional","affiliation":[{"name":"Heart and Vascular Centre, Semmelweis University , 68. Varosmajor u, 1122-Budapest ,","place":["Hungary"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Rakovics","sequence":"additional","affiliation":[{"name":"Centre for Translational Medicine, Semmelweis University , Budapest ,","place":["Hungary"]},{"name":"Department of Statistics, ELTE E\u00f6tv\u00f6s Lor\u00e1nd University , Faculty of Social Sciences, Budapest,","place":["Hungary"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Medicine Huddinge, Karolinska Institutet , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Manouras","sequence":"additional","affiliation":[{"name":"Department of Medicine Huddinge, Karolinska Institutet , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0519-5172","authenticated-orcid":false,"given":"A I","family":"Nagy","sequence":"additional","affiliation":[{"name":"Heart and Vascular Centre, Semmelweis University , 68. Varosmajor u, 1122-Budapest ,","place":["Hungary"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,10,29]]},"reference":[{"key":"2025013023574947400_jeae276-B1","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1136\/hrt.2010.198853","article-title":"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","volume":"97","author":"Cueff","year":"2011","journal-title":"Heart"},{"key":"2025013023574947400_jeae276-B2","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1016\/S0009-9260(03)00184-3","article-title":"Aortic valve calcification on computed tomography predicts the severity of aortic stenosis","volume":"58","author":"Cowell","year":"2003","journal-title":"Clin Radiol"},{"key":"2025013023574947400_jeae276-B3","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1161\/01.CIR.0000135469.82545.D0","article-title":"Evaluation and clinical implications of aortic valve calcification measured by electron-beam computed tomography","volume":"110","author":"Messika-Zeitoun","year":"2004","journal-title":"Circulation"},{"key":"2025013023574947400_jeae276-B4","doi-asserted-by":"crossref","first-page":"4207","DOI":"10.1093\/eurheartj\/ehab626","article-title":"2021 ESC\/EACTS guidelines for the management of valvular heart disease","volume":"42","author":"Vahanian","year":"2021","journal-title":"Eur Heart J"},{"key":"2025013023574947400_jeae276-B5","doi-asserted-by":"crossref","first-page":"673519","DOI":"10.3389\/fcvm.2021.673519","article-title":"Diagnostic and prognostic accuracy of aortic valve calcium scoring in patients with moderate-to-severe aortic stenosis","volume":"8","author":"Boulif","year":"2021","journal-title":"Front Cardiovasc Med"},{"key":"2025013023574947400_jeae276-B6","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1253\/circrep.CR-22-0035","article-title":"Revisiting the aortic valve calcium score in evaluating the severity of aortic stenosis in Japanese patients\u2014a single-center study","volume":"4","author":"Katagiri","year":"2022","journal-title":"Circ Rep"},{"key":"2025013023574947400_jeae276-B7","doi-asserted-by":"crossref","first-page":"e015610","DOI":"10.1161\/JAHA.119.015610","article-title":"Age, sex, and valve phenotype differences in fibro-calcific remodeling of calcified aortic valve","volume":"9","author":"Voisine","year":"2020","journal-title":"J Am Heart Assoc"},{"key":"2025013023574947400_jeae276-B8","doi-asserted-by":"crossref","first-page":"e011433","DOI":"10.1161\/CIRCIMAGING.120.011433","article-title":"Aortic valve calcium in patients with transthyretin cardiac amyloidosis: a propensity-matched analysis","volume":"13","author":"Hussain","year":"2020","journal-title":"Circ Cardiovasc Imaging"},{"key":"2025013023574947400_jeae276-B9","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1016\/j.echo.2017.02.009","article-title":"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","volume":"30","author":"Baumgartner","year":"2017","journal-title":"J Am Soc Echocardiogr"},{"key":"2025013023574947400_jeae276-B10","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1016\/0735-1097(90)90282-T","article-title":"Quantification of coronary artery calcium using ultrafast computed tomography","volume":"15","author":"Agatston","year":"1990","journal-title":"J Am Coll Cardiol"},{"key":"2025013023574947400_jeae276-B11","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/j.jacc.2017.11.052","article-title":"Dobutamine stress echocardiography for management of low-flow, low-gradient aortic stenosis","volume":"71","author":"Annabi","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"2025013023574947400_jeae276-B12","doi-asserted-by":"crossref","first-page":"e011168","DOI":"10.1161\/JAHA.118.011168","article-title":"Contemporary outcomes in low-gradient aortic stenosis patients who underwent dobutamine stress echocardiography","volume":"8","author":"Sato","year":"2019","journal-title":"J Am Heart Assoc"},{"key":"2025013023574947400_jeae276-B13","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1016\/j.jacc.2020.11.035","article-title":"2020 ACC\/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology\/American Heart Association joint committee on clinical practice guidelines","volume":"77","author":"Otto","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"2025013023574947400_jeae276-B14","doi-asserted-by":"crossref","first-page":"2329","DOI":"10.1016\/j.jacc.2013.08.1621","article-title":"The complex nature of discordant severe calcified aortic valve disease grading: new insights from combined Doppler echocardiographic and computed tomographic study","volume":"62","author":"Clavel","year":"2013","journal-title":"J Am Coll Cardiol"},{"key":"2025013023574947400_jeae276-B15","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1161\/CIRCRESAHA.116.309306","article-title":"Sex-Related discordance between aortic valve calcification and hemodynamic severity of aortic stenosis: is valvular fibrosis the explanation?","volume":"120","author":"Simard","year":"2017","journal-title":"Circ Res"},{"key":"2025013023574947400_jeae276-B16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ccl.2019.09.010","article-title":"Pathophysiology of aortic stenosis and future perspectives for medical therapy","volume":"38","author":"Zheng","year":"2020","journal-title":"Cardiol Clin"},{"key":"2025013023574947400_jeae276-B17","doi-asserted-by":"crossref","first-page":"8019","DOI":"10.1038\/s41598-023-34118-7","article-title":"Diagnostic role of aortic valve calcium scoring in various etiologies of aortic stenosis","volume":"13","author":"Wanchaitanawong","year":"2023","journal-title":"Sci Rep"},{"key":"2025013023574947400_jeae276-B18","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1136\/heartjnl-2016-309665","article-title":"Effect of age and aortic valve anatomy on calcification and haemodynamic severity of aortic stenosis","volume":"103","author":"Shen","year":"2017","journal-title":"Heart"},{"key":"2025013023574947400_jeae276-B19","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1136\/heartjnl-2023-323281","article-title":"Computed tomography calcium scoring in aortic stenosis: bicuspid versus tricuspid morphology","volume":"110","author":"Ye","year":"2024","journal-title":"Heart"},{"key":"2025013023574947400_jeae276-B20","doi-asserted-by":"crossref","first-page":"2638","DOI":"10.1016\/j.jacc.2019.09.056","article-title":"Aortic stenosis and cardiac amyloidosis: JACC review topic of the week","volume":"74","author":"Ternacle","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"2025013023574947400_jeae276-B21","doi-asserted-by":"crossref","first-page":"ehab724.1816","DOI":"10.1093\/eurheartj\/ehab724.1816","article-title":"Different aortic valve calcium scores by computed tomography scan in patients with severe aortic stenosis and concomitant cardiac amyloidosis","volume":"42","author":"Saturi","year":"2021","journal-title":"Eur Heart J"},{"key":"2025013023574947400_jeae276-B22","doi-asserted-by":"crossref","first-page":"e007146","DOI":"10.1161\/CIRCIMAGING.117.007146","article-title":"Computed tomography aortic valve calcium scoring in patients with aortic stenosis","volume":"11","author":"Pawade","year":"2018","journal-title":"Circ Cardiovasc Imaging"},{"key":"2025013023574947400_jeae276-B23","doi-asserted-by":"crossref","first-page":"e210075","DOI":"10.1148\/ryct.2021210075","article-title":"Diagnostic and prognostic performance of aortic valve calcium score with cardiac CT for aortic stenosis: a meta-analysis","volume":"3","author":"Wang","year":"2021","journal-title":"Radiol Cardiothorac Imaging"},{"key":"2025013023574947400_jeae276-B24","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1002\/clc.22212","article-title":"Significance of aortic valve calcification in patients with low-gradient low-flow aortic stenosis","volume":"37","author":"Aksoy","year":"2014","journal-title":"Clin Cardiol"},{"key":"2025013023574947400_jeae276-B25","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1016\/j.jcmg.2024.03.014","article-title":"Diagnostic value of aortic valve calcification levels in the assessment of low-gradient aortic stenosis","volume":"17","author":"Adrichem","year":"2024","journal-title":"JACC Cardiovasc Imaging"},{"key":"2025013023574947400_jeae276-B26","doi-asserted-by":"crossref","first-page":"1851","DOI":"10.1016\/j.jacc.2019.08.004","article-title":"Poor long-term survival in patients with moderate aortic stenosis","volume":"74","author":"Strange","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"2025013023574947400_jeae276-B27","doi-asserted-by":"crossref","first-page":"2276","DOI":"10.1093\/eurheartj\/ehv701","article-title":"Aortic valve surgery and survival in patients with moderate or severe aortic stenosis and left ventricular dysfunction","volume":"37","author":"Samad","year":"2016","journal-title":"Eur Heart J"},{"key":"2025013023574947400_jeae276-B28","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.jacc.2008.09.022","article-title":"Impact of prosthesis-patient mismatch on long-term survival after aortic valve replacement: influence of age, obesity, and left ventricular dysfunction","volume":"53","author":"Mohty","year":"2009","journal-title":"J Am Coll Cardiol"},{"key":"2025013023574947400_jeae276-B29","doi-asserted-by":"crossref","first-page":"1664","DOI":"10.1016\/j.jcin.2022.06.022","article-title":"Impact of moderate aortic stenosis on long-term clinical outcomes: a systematic review and meta-analysis","volume":"15","author":"Coisne","year":"2022","journal-title":"JACC Cardiovasc Interv"},{"key":"2025013023574947400_jeae276-B30","doi-asserted-by":"crossref","first-page":"2383","DOI":"10.1016\/j.jacc.2017.03.023","article-title":"Prognostic implications of moderate aortic stenosis in patients with left ventricular systolic dysfunction","volume":"69","author":"van Gils","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"2025013023574947400_jeae276-B31","doi-asserted-by":"crossref","first-page":"e012768","DOI":"10.1161\/CIRCINTERVENTIONS.122.012768","article-title":"Transcatheter aortic valve replacement in patients with reduced ejection fraction and nonsevere aortic stenosis","volume":"16","author":"Ludwig","year":"2023","journal-title":"Circ Cardiovasc Interv"},{"key":"2025013023574947400_jeae276-B32","doi-asserted-by":"crossref","first-page":"2796","DOI":"10.1016\/j.jacc.2021.04.014","article-title":"Moderate aortic stenosis in patients with heart failure and reduced ejection fraction","volume":"77","author":"Jean","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"2025013023574947400_jeae276-B33","doi-asserted-by":"crossref","first-page":"e017870","DOI":"10.1161\/JAHA.120.017870","article-title":"Comparison of early surgical or transcatheter aortic valve replacement versus conservative management in low-flow, low-gradient aortic stenosis using inverse probability of treatment weighting: results from the TOPAS prospective observational cohort study","volume":"9","author":"Annabi","year":"2020","journal-title":"J Am Heart Assoc"},{"key":"2025013023574947400_jeae276-B34","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.ahj.2016.08.009","article-title":"Rationale and design of the transcatheter aortic valve replacement to UNload the left ventricle in patients with ADvanced heart failure (TAVR UNLOAD) trial","volume":"182","author":"Spitzer","year":"2016","journal-title":"Am Heart J"}],"container-title":["European Heart Journal - Cardiovascular Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/advance-article-pdf\/doi\/10.1093\/ehjci\/jeae276\/60541707\/jeae276.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article-pdf\/26\/2\/287\/60541707\/jeae276.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article-pdf\/26\/2\/287\/60541707\/jeae276.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T23:58:23Z","timestamp":1738281503000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article\/26\/2\/287\/7848645"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,29]]},"references-count":34,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,10,29]]},"published-print":{"date-parts":[[2025,1,31]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjci\/jeae276","relation":{},"ISSN":["2047-2404","2047-2412"],"issn-type":[{"value":"2047-2404","type":"print"},{"value":"2047-2412","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,2]]},"published":{"date-parts":[[2024,10,29]]}}}