{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T07:10:17Z","timestamp":1781248217953,"version":"3.54.1"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>\n                      Computed tomography based planimetric assessment of the anatomic aortic valve area (aAVA\n                      <jats:sup>CTA<\/jats:sup>\n                      ) in aortic stenosis is routinely performed. Unlike transthoracic echocardiography (TTE)-based effective AVA by TTE, it lacks clearly defined severity cutoff values, limiting clinical utility.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>In this retrospective single-center analysis with computed tomography angiography data from 2013 to 2025, cutoffs were determined from 1294 TTE-based conclusive severe or nonsevere patients by congruence of maximum velocity, mean pressure gradient, and effective AVA by TTE. In separate receiver operator curves analyses for tricuspid and bicuspid valves, the severe stenosis likely cutoff was defined by Youden index and the unlikely cutoff by a negative likelihood ratio &lt;0.1. Cutoffs were internally validated in 480 patients, compared with the Agatston score by net reclassification index, and tested in 190 separate normal-flow low-gradient aortic stenosis cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Correlation between aAVA\n                      <jats:sup>CTA<\/jats:sup>\n                      and effective AVA by TTE was moderate and strong in tricuspid and bicuspid valves, respectively (Pearson\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      0.67 and 0.78;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001). Severe stenosis was likely in tricuspid valves at aAVA\n                      <jats:sup>CTA<\/jats:sup>\n                      \u22640.95 cm\u00b2 (sensitivity 87%, specificity 78.9%) and unlikely at \u22651.10 cm\u00b2 (negative likelihood ratio, 0.092). In bicuspid valves severe stenosis was likely at aAVA\n                      <jats:sup>CTA<\/jats:sup>\n                      \u22641.08 cm\u00b2 (sensitivity 88.3%, specificity 77.3%) and unlikely at \u22651.20cm\n                      <jats:sup>2<\/jats:sup>\n                      (negative likelihood ratio, 0.091). Validation showed comparable results. Net reclassification index compared with the Agatston score was 0.16 for likely and 0.17 for unlikely cutoffs (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001). Cutoffs were applied to 190 suspected severe low-gradient cases. Adding aAVA\n                      <jats:sup>CTA<\/jats:sup>\n                      as an additional severity marker led to reclassification to nonsevere in 5.8% of cases.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Direct planimetry of AVA is feasible and shows utility in low gradient-aortic stenosis. However, as the hemodynamic effect is impacted by valve shape, cutoff values should differentiate between tricuspid and bicuspid valves.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circimaging.125.018677","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T10:00:36Z","timestamp":1769076036000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Planimetry of Aortic Valve Area Using CTA: Cutoff Derivation for Stenotic Bicuspid and Tricuspid Valves"],"prefix":"10.1161","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1046-4874","authenticated-orcid":true,"given":"Silvia","family":"Voegele","sequence":"first","affiliation":[{"name":"Department of Cardiology and Angiology (S.V., J.M., N.J., S.G., P.R., C.W., T.H., C.v.z.M., D.W., M.H.), Medical Center \u2013 University of Freiburg, Faculty of Medicine, University of Freiburg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7094-8348","authenticated-orcid":true,"given":"Jan","family":"Minners","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology (S.V., J.M., N.J., S.G., P.R., C.W., T.H., C.v.z.M., D.W., M.H.), Medical Center \u2013 University of Freiburg, Faculty of Medicine, University of Freiburg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaus","family":"Jander","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology (S.V., J.M., N.J., S.G., P.R., C.W., T.H., C.v.z.M., D.W., M.H.), Medical Center \u2013 University of Freiburg, Faculty of Medicine, University of Freiburg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6416-6873","authenticated-orcid":true,"given":"Sebastian","family":"Grundmann","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology (S.V., J.M., N.J., S.G., P.R., C.W., T.H., C.v.z.M., D.W., M.H.), Medical Center \u2013 University of Freiburg, Faculty of Medicine, University of Freiburg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1822-3038","authenticated-orcid":true,"given":"Philipp","family":"Ruile","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology (S.V., J.M., N.J., S.G., P.R., C.W., T.H., C.v.z.M., D.W., M.H.), Medical Center \u2013 University of Freiburg, Faculty of Medicine, University of Freiburg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0837-6945","authenticated-orcid":true,"given":"Klaus","family":"Kaier","sequence":"additional","affiliation":[{"name":"Institute of Medical Biometry and Statistics (K.K.), Medical Center \u2013 University of Freiburg, Faculty of Medicine, University of Freiburg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1576-1481","authenticated-orcid":true,"given":"Christopher L.","family":"Schlett","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology (C.L.S, M.S.), Medical Center \u2013 University of Freiburg, Faculty of Medicine, University of Freiburg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6314-1829","authenticated-orcid":true,"given":"Martin","family":"Soschynski","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology (C.L.S, M.S.), Medical Center \u2013 University of Freiburg, Faculty of Medicine, University of Freiburg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7676-1223","authenticated-orcid":true,"given":"Christian","family":"Weber","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology (S.V., J.M., N.J., S.G., P.R., C.W., T.H., C.v.z.M., D.W., M.H.), Medical Center \u2013 University of Freiburg, Faculty of Medicine, University of Freiburg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timo","family":"Heidt","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology (S.V., J.M., N.J., S.G., P.R., C.W., T.H., C.v.z.M., D.W., M.H.), Medical Center \u2013 University of Freiburg, Faculty of Medicine, University of Freiburg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constantin","family":"von zur M\u00fchlen","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology (S.V., J.M., N.J., S.G., P.R., C.W., T.H., C.v.z.M., D.W., M.H.), Medical Center \u2013 University of Freiburg, Faculty of Medicine, University of Freiburg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7542-1956","authenticated-orcid":true,"given":"Dirk","family":"Westermann","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology (S.V., J.M., N.J., S.G., P.R., C.W., T.H., C.v.z.M., D.W., M.H.), Medical Center \u2013 University of Freiburg, Faculty of Medicine, University of Freiburg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0430-7184","authenticated-orcid":true,"given":"Manuel","family":"Hein","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology (S.V., J.M., N.J., S.G., P.R., C.W., T.H., C.v.z.M., D.W., M.H.), Medical Center \u2013 University of Freiburg, Faculty of Medicine, University of Freiburg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000923"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaf194"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2017.02.009"},{"key":"e_1_3_3_5_2","first-page":"23","article-title":"Aortic stenosis: physics and physiology--what do the numbers really mean?","volume":"6","author":"Weyman AE","year":"2005","unstructured":"Weyman AE, Scherrer-Crosbie M. Aortic stenosis: physics and physiology--what do the numbers really mean? Rev Cardiovasc Med. 2005;6:23\u201332. https:\/\/pubmed.ncbi.nlm.nih.gov\/15741922\/","journal-title":"Rev Cardiovasc Med"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehm543"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(90)90260-v"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0735-1097(02)02269-6"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2019.01.045"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.121.021126"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1111\/echo.15664"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.diii.2017.12.007"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.00264.2003"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1111\/echo.12712"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jev188"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2007.01.039"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1055\/b-005-145238"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-030-72941-7"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-981-97-6919-3"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2022.1035244"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000029"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.894170"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10554-009-9464-z"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1115\/1.3242391"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1111\/echo.13855"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2015.01.009"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.08.1986"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.shj.2022.100119"}],"container-title":["Circulation: Cardiovascular Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCIMAGING.125.018677","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T18:00:24Z","timestamp":1773770424000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCIMAGING.125.018677"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":27,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1161\/CIRCIMAGING.125.018677"],"URL":"https:\/\/doi.org\/10.1161\/circimaging.125.018677","relation":{},"ISSN":["1941-9651","1942-0080"],"issn-type":[{"value":"1941-9651","type":"print"},{"value":"1942-0080","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]},"assertion":[{"value":"2025-06-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-17","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}