{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T23:25:23Z","timestamp":1792452323675,"version":"4.5.0"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"16","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2023,8,15]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">A total of 40% of patients with severe aortic stenosis (AS) have low\u2010gradient AS, raising uncertainty about AS severity. Aortic valve calcification, measured by computed tomography (CT), is guideline\u2010endorsed to aid in such cases. The performance of different CT\u2010derived aortic valve areas (AVAs) is less well studied.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Consecutive adult patients with presumed moderate and severe AS based on echocardiography (AVA measured by continuity equation on echocardiography &lt;1.5\u2009cm\n              <jats:sup>2<\/jats:sup>\n              ) who underwent cardiac CT were identified retrospectively. AVAs, measured by direct planimetry on CT (AVA\n              <jats:sub>CT<\/jats:sub>\n              ) and by a hybrid approach (AVA measured in a hybrid manner with echocardiography and CT [AVA\n              <jats:sub>Hybrid<\/jats:sub>\n              ]), were measured. Sex\u2010specific aortic valve calcification thresholds (\u22651200 Agatston units in women and \u22652000 Agatston units in men) were applied to adjudicate severe or nonsevere AS. A total of 215 patients (38.0% women; mean\u00b1SD age, 78\u00b18\u2009years) were included: normal flow, 59.5%; and low flow, 40.5%. Among the different thresholds for AVA\n              <jats:sub>CT<\/jats:sub>\n              and AVA\n              <jats:sub>Hybrid<\/jats:sub>\n              , diagnostic performance was the best for AVA\n              <jats:sub>CT<\/jats:sub>\n              &lt;1.2\u2009cm\n              <jats:sup>2<\/jats:sup>\n              (sensitivity, 85%; specificity, 26%; and accuracy, 72%), with no significant difference by flow status. The percentage of patients with correctly classified AS severity (correctly classified severe AS+correctly classified moderate AS) was as follows; AVA measured by continuity equation on echocardiography &lt;1.0\u2009cm\n              <jats:sup>2<\/jats:sup>\n              , 77%; AVA\n              <jats:sub>CT<\/jats:sub>\n              &lt;1.2\u2009cm\n              <jats:sup>2<\/jats:sup>\n              , 73%; AVA\n              <jats:sub>CT<\/jats:sub>\n              &lt;1.0\u2009cm\n              <jats:sup>2<\/jats:sup>\n              , 58%; AVA\n              <jats:sub>Hybrid<\/jats:sub>\n              &lt;1.2\u2009cm\n              <jats:sup>2<\/jats:sup>\n              , 59%; and AVA\n              <jats:sub>Hybrid<\/jats:sub>\n              &lt;1.0\u2009cm\n              <jats:sup>2<\/jats:sup>\n              , 45%. AVA\n              <jats:sub>CT<\/jats:sub>\n              cut points of 1.52\u2009cm\n              <jats:sup>2<\/jats:sup>\n              for normal flow and 1.56\u2009cm\n              <jats:sup>2<\/jats:sup>\n              for low flow, provided 95% specificity for excluding severe AS.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              CT\u2010derived AVAs have poor discrimination for AS severity. Using an AVA\n              <jats:sub>CT<\/jats:sub>\n              &lt;1.2\u2010cm\n              <jats:sup>2<\/jats:sup>\n              threshold to define severe AS can produce significant error. Larger AVA\n              <jats:sub>CT<\/jats:sub>\n              thresholds improve specificity.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.123.029973","type":"journal-article","created":{"date-parts":[[2023,8,10]],"date-time":"2023-08-10T10:36:27Z","timestamp":1691663787000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":26,"title":["Performance of Computed Tomographic Angiography\u2013Based Aortic Valve Area for Assessment of Aortic Stenosis"],"prefix":"10.1161","volume":"12","author":[{"given":"Jerry","family":"Ash","sequence":"first","affiliation":[{"name":"Cardiovascular Division, Department of Medicine University of Minnesota Medical School Minneapolis MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gurmandeep S.","family":"Sandhu","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Department of Medicine University of Minnesota Medical School Minneapolis MN"},{"name":"Department of Medicine University of Minnesota Medical School Minneapolis MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6921-7230","authenticated-orcid":false,"given":"Jose","family":"Arriola\u2010Montenegro","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Minnesota Medical School Minneapolis MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dzhalal","family":"Agakishiev","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Minnesota Medical School Minneapolis MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8924-740X","authenticated-orcid":false,"given":"Marie\u2010Annick","family":"Clavel","sequence":"additional","affiliation":[{"name":"Institut Universitaire de Cardiologie et de Pneumologie de Qu\u00e9bec (Quebec Heart and Lung Institute) Laval University Quebec City Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3607-279X","authenticated-orcid":false,"given":"Philippe","family":"Pibarot","sequence":"additional","affiliation":[{"name":"Institut Universitaire de Cardiologie et de Pneumologie de Qu\u00e9bec (Quebec Heart and Lung Institute) Laval University Quebec City Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1025-8665","authenticated-orcid":false,"given":"Sue","family":"Duval","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Department of Medicine University of Minnesota Medical School Minneapolis MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8681-1397","authenticated-orcid":false,"given":"Prabhjot S.","family":"Nijjar","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Department of Medicine University of Minnesota Medical School Minneapolis MN"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.119.041080"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000923"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab626"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2017.01.002"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2018.11.027"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.05.066"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.117.007146"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10554-009-9464-z"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10554-013-0295-6"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jjcc.2013.08.002"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2015.01.009"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2018.06.004"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcct.2018.11.008"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1136\/openhrt-2019-001044"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.02.046"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.002310"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.119.015610"}],"container-title":["Journal 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