Computed tomography coronary angiography demonstrated diagnostic accuracy for aortic stenosis detection and severity grading in a new study, achieving 99.2% sensitivity and 98.9% specificity when compared with standard echocardiography.
The study of 920 patients referred for CT coronary angiography within 6 months of echocardiographic evaluation found that 384-slice dual-source CT angiographic imaging accurately diagnosed and quantified aortic stenosis severity with agreement rates exceeding 96% across multiple echocardiographic parameters. CT-derived classifications using aortic valve area showed "strong correlation with transthoracic echocardiography in AS grading severity based upon quantification of AVA, peak velocity, and mean gradient, with agreement of 98.19%, 96.81%, and 96.70%, respectively," noted Sara Mashayekan, MD, from UCSF Health St Mary's Hospital in San Francisco, and colleagues.
Their research was chosen as a 2025 Arthur E. Weyman Young Investigator’s Award Competition Finalist. Findings were presented at the American Society of Echocardiography 2025 annual meeting and as an abstract in the Journal of the American Society of Echocardiography.
The patient cohort included 510 males and 410 females with a mean age of 70.7 years. Echocardiography identified aortic stenosis in 199 patients (21.6%), aortic insufficiency in 107 patients (11.6%), and both conditions in 265 patients (28.8%).
For aortic insufficiency detection, CT demonstrated different performance characteristics, with a sensitivity of 28.8% and a specificity of 97.2%. However, the imaging modality proved effective at distinguishing clinically significant cases, correctly classifying patients into either moderate-to-severe or absent-to-mild severity categories with 98% agreement using transthoracic echocardiography-based classifications.
While echocardiography remains the standard diagnostic technique for valvular pathology, CT coronary angiography has emerged as a potential primary diagnostic method for aortic stenosis, with researchers concluding that the imaging protocol "was shown to accurately determine the presence of clinically significant AI" despite lower overall sensitivity for aortic insufficiency detection.
The statistical analysis revealed a kappa coefficient of 0.786 for aortic insufficiency classification, indicating substantial agreement between imaging modalities for clinically relevant disease severity determination.
Disclosures were not made available at press time.
