International journal of cardiology · 2026
Diagnostic performance of aortic valve calcium scoring for severe aortic stenosis in patients with chronic kidney disease.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Sheashaa Hesham, Farina Juan M, Scalia Isabel G, Awad Kamal, Abbas Mohammed Tiseer, Pereyra Milagros, Ahmed Sherif, Abdelfattah Fatmaelzahraa, Razaghi Mahshad, Hafez Abdelrahman, Ibrahim Ramzi, Alsidawi Said, Lester Steven J, Fortuin David, Sweeney John, Sell-Dottin Kristen, Ayoub Chadi, Arsanjani Reza
Аннотация
BACKGROUND: Aortic valve calcium scoring (AVCS) via noncontrast Computed Tomography (CT) has emerged as a valuable adjunct to echocardiography in diagnosing aortic stenosis (AS). However, its diagnostic accuracy in patients with chronic kidney disease (CKD) -a population characterized by extensive extra-valvular calcification- remains unclear.
METHODS: This retrospective multicenter study included 2909 adults who underwent AVCS and echocardiography between 2015 and 2025 across Mayo Clinic sites. Patients were stratified by glomerular filtration rate (eGFR) to assess AVCS diagnostic performance for severe AS in CKD vs non-CKD cohorts. Receiver operating characteristic (ROC) curves, stratified by sex and eGFR categories, were used to evaluate diagnostic accuracy. Optimal thresholds were derived using Youden's index and compared with guideline-recommended cutoffs.
RESULTS: AVCS demonstrated high diagnostic accuracy in patients with preserved renal function (AUC 0.861), but performance declined with worsening CKD. AUC dropped to 0.791 (eGFR <60), 0.727 (eGFR <45), and 0.691 (eGFR <30). Specificity declined significantly across worsening eGFR, despite stable sensitivity. Sex-stratified analysis revealed similar results.
CONCLUSION: AVCS remains a reliable tool to rule out severe AS in patients with CKD, but declining specificity with worsening kidney function -likely due to nonvalvular calcification- highlights the risk of false positives. In CKD populations, AVCS thresholds should be interpreted cautiously and integrated with multimodal evaluation and clinical data.
METHODS: This retrospective multicenter study included 2909 adults who underwent AVCS and echocardiography between 2015 and 2025 across Mayo Clinic sites. Patients were stratified by glomerular filtration rate (eGFR) to assess AVCS diagnostic performance for severe AS in CKD vs non-CKD cohorts. Receiver operating characteristic (ROC) curves, stratified by sex and eGFR categories, were used to evaluate diagnostic accuracy. Optimal thresholds were derived using Youden's index and compared with guideline-recommended cutoffs.
RESULTS: AVCS demonstrated high diagnostic accuracy in patients with preserved renal function (AUC 0.861), but performance declined with worsening CKD. AUC dropped to 0.791 (eGFR <60), 0.727 (eGFR <45), and 0.691 (eGFR <30). Specificity declined significantly across worsening eGFR, despite stable sensitivity. Sex-stratified analysis revealed similar results.
CONCLUSION: AVCS remains a reliable tool to rule out severe AS in patients with CKD, but declining specificity with worsening kidney function -likely due to nonvalvular calcification- highlights the risk of false positives. In CKD populations, AVCS thresholds should be interpreted cautiously and integrated with multimodal evaluation and clinical data.