{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:13:58Z","timestamp":1787314438340,"version":"build-2736575974"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Aortic valve calcification (AVC) has been shown to be a powerful assessment of aortic stenosis (AS) severity and a predictor of adverse outcomes. However, its accuracy in patients with low-flow AS has not yet been proven. The objective of the study was to assess the predictive value of AVC in patients with classical low-flow (CLF, that is, low-flow reduced left ventricular ejection fraction) or paradoxical low-flow (PLF, that is, low-flow preserved left ventricular ejection fraction) AS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>We prospectively included 641 patients, 319 (49.8%) with CLF-AS and 322 (50.2%) with PLF-AS, who underwent Doppler echocardiography and multidetector computed tomography. AVC ratio (AVCratio) was calculated as AVC divided by the sex-specific AVC threshold for AS severity; AVC score \u22652000 Agatston units in male patients and \u22651200 Agatston units in female patients. The primary end point of the study was all-cause mortality regardless of treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Sex-specific AVC thresholds identified AS severity correctly in 137 (87%) of the patients. During a median follow-up of 4.9 (4.3\u20135.9) years, there were 265 deaths. After comprehensive adjustment, AVCratio was associated with all-cause mortality in patients with CLF-AS (adjusted hazard ratio, 1.25 [95% CI, 1.01\u20131.56];\n                      <jats:italic>P<\/jats:italic>\n                      =0.046) and PLF-AS (adjusted hazard ratio, 1.51 [95% CI, 1.14\u20132.00];\n                      <jats:italic>P<\/jats:italic>\n                      =0.004). There was an interaction (\n                      <jats:italic>P<\/jats:italic>\n                      =0.001) between AVC and AS flow patterns (ie, CLF versus PLF) with regard to the prediction of mortality. The best AVCratio threshold to predict mortality was different in patients with CLF-AS (AVCratio \u22650.7) and PLF-AS (AVCratio \u22651). After a comprehensive analysis, AVCratio as a dichotomic variable was associated with all-cause mortality in all groups (\n                      <jats:italic>P<\/jats:italic>\n                      \u22640.001). The addition of AVCratio to the models improved all models\u2019 predictive value (all net reclassification index &gt;18%; all\n                      <jats:italic>P<\/jats:italic>\n                      \u22640.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>In patients with CLF-AS or PLF-AS, AVC is a major predictor of mortality. Thus, AVC should be used in low-flow patients to assess AS severity and stratify risk. Importantly, in patients with reduced left ventricular ejection fraction, a nonsevere AS (ie, AVC 70% of severe) could be associated with reduced survival.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circimaging.124.017122","type":"journal-article","created":{"date-parts":[[2025,1,8]],"date-time":"2025-01-08T05:02:20Z","timestamp":1736312540000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Usefulness of Aortic Valve Calcification in Patients With Low-Flow Aortic Stenosis"],"prefix":"10.1161","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8137-6496","authenticated-orcid":true,"given":"Nils Sofus Borg","family":"Mogensen","sequence":"first","affiliation":[{"name":"Department of Cardiology, Odense University Hospital, Denmark (N.S.B.M., J.S.D., M.A., A.H., R.C.-S., J.E.M., K.A.\u00d8., M.-A.C.)."},{"name":"Research center, Institut Universitaire de Cardiologie et de Pneumologie de Qu\u00e9bec (Qu\u00e9bec Heart and Lung Institute), Laval University, Canada (N.S.B.M., M.-S.A., A.H., A.P., J.G.-D., P.P., M.-A.C.)."},{"name":"Clinical Institute, University of Southern Denmark, Odense (N.S.B.M., J.S.D., R.C.-S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordi","family":"Sanchez Dahl","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Odense University Hospital, Denmark (N.S.B.M., J.S.D., M.A., A.H., R.C.-S., J.E.M., K.A.\u00d8., M.-A.C.)."},{"name":"Clinical Institute, University of Southern Denmark, Odense (N.S.B.M., J.S.D., R.C.-S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2855-1713","authenticated-orcid":true,"given":"Mulham","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Odense University Hospital, Denmark (N.S.B.M., J.S.D., M.A., A.H., R.C.-S., J.E.M., K.A.\u00d8., M.-A.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2835-9472","authenticated-orcid":true,"given":"Mohamed-Salah","family":"Annabi","sequence":"additional","affiliation":[{"name":"Research center, Institut Universitaire de Cardiologie et de Pneumologie de Qu\u00e9bec (Qu\u00e9bec Heart and Lung Institute), Laval University, Canada (N.S.B.M., M.-S.A., A.H., A.P., J.G.-D., P.P., M.-A.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5747-6839","authenticated-orcid":true,"given":"Amal","family":"Haujir","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Odense University Hospital, Denmark (N.S.B.M., J.S.D., M.A., A.H., R.C.-S., J.E.M., K.A.\u00d8., M.-A.C.)."},{"name":"Research center, Institut Universitaire de Cardiologie et de Pneumologie de Qu\u00e9bec (Qu\u00e9bec Heart and Lung Institute), Laval University, Canada (N.S.B.M., M.-S.A., A.H., A.P., J.G.-D., P.P., M.-A.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6655-669X","authenticated-orcid":true,"given":"Andr\u00e9anne","family":"Powers","sequence":"additional","affiliation":[{"name":"Research center, Institut Universitaire de Cardiologie et de Pneumologie de Qu\u00e9bec (Qu\u00e9bec Heart and Lung Institute), Laval University, Canada (N.S.B.M., M.-S.A., A.H., A.P., J.G.-D., P.P., M.-A.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rasmus","family":"Carter-Storch","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Odense University Hospital, Denmark (N.S.B.M., J.S.D., M.A., A.H., R.C.-S., J.E.M., K.A.\u00d8., M.-A.C.)."},{"name":"Clinical Institute, University of Southern Denmark, Odense (N.S.B.M., J.S.D., R.C.-S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasmine","family":"Grenier-Delaney","sequence":"additional","affiliation":[{"name":"Research center, Institut Universitaire de Cardiologie et de Pneumologie de Qu\u00e9bec (Qu\u00e9bec Heart and Lung Institute), Laval University, Canada (N.S.B.M., M.-S.A., A.H., A.P., J.G.-D., P.P., M.-A.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2873-5845","authenticated-orcid":true,"given":"Jacob Eifer","family":"M\u00f8ller","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Odense University Hospital, Denmark (N.S.B.M., J.S.D., M.A., A.H., R.C.-S., J.E.M., K.A.\u00d8., M.-A.C.)."},{"name":"Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark (J.E.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristian Altern","family":"\u00d8vrehus","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Odense University Hospital, Denmark (N.S.B.M., J.S.D., M.A., A.H., R.C.-S., J.E.M., K.A.\u00d8., 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