Coronary artery disease · 2026
Diagnostic agreement of volume and Agatston scoring for aortic valve calcification on non-ECG-gated computed tomography in severe aortic stenosis.
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Ouchi Kotaro, Sakuma Toru, Okubo Shu, Nojiri Ayumi, Ojiri Hiroya
Аннотация
OBJECTIVES: To assess whether non-ECG-gated computed tomography (CT) reliably quantifies aortic valve calcification (AVC) for diagnosing severe aortic stenosis and to compare the agreement and diagnostic performance of Agatston versus volume scoring.
METHODS: In this retrospective single-centre study, 129 consecutive patients with echocardiographically confirmed severe aortic stenosis (mean age, 83.1 ± 6.3 years; 46 men, 83 women) underwent same-session ECG-gated (3 mm) and Non-ECG-gated (5 mm) non-contrast CT between 21 March 2020 and 16 April 2025. AVC was quantified using Agatston and volume methods. Agreement between non-gated and gated scores was assessed by Pearson correlation, Bland-Altman analysis, and Deming regression. Diagnostic performance for sex-specific Agatston thresholds (≥2000 units men, ≥1300 units women) was evaluated using receiver operating characteristic (ROC) analysis.
RESULTS: Volume scores on non-ECG-gated CT correlated more strongly with ECG-gated CT scores than Agatston scores ( r = 0.95 vs. 0.69, P < 0.001). Bland-Altman analysis demonstrated substantial negative bias and proportional error for Agatston scores (mean difference, -921.1 units; limits of agreement, -2900.8 to +1058.6), while volume scores showed minimal bias and no proportional error (+16.5 mm 3 ; -648.5 to +681.4). Deming regression confirmed closer agreement for volume scores (slope, 1.02; R2 = 0.90). ROC analysis showed higher area under the curve values for volume scores (0.976 for men, 0.975 for women) than for Agatston scores (0.946 and 0.967, respectively).
CONCLUSION: Non-ECG-gated CT enables reliable quantification of aortic valve calcium in severe aortic stenosis. Volume scoring demonstrates superior agreement and diagnostic performance compared with Agatston scoring, supporting its use as a robust, density-independent metric for opportunistic assessment of AVC on routine chest CT.
METHODS: In this retrospective single-centre study, 129 consecutive patients with echocardiographically confirmed severe aortic stenosis (mean age, 83.1 ± 6.3 years; 46 men, 83 women) underwent same-session ECG-gated (3 mm) and Non-ECG-gated (5 mm) non-contrast CT between 21 March 2020 and 16 April 2025. AVC was quantified using Agatston and volume methods. Agreement between non-gated and gated scores was assessed by Pearson correlation, Bland-Altman analysis, and Deming regression. Diagnostic performance for sex-specific Agatston thresholds (≥2000 units men, ≥1300 units women) was evaluated using receiver operating characteristic (ROC) analysis.
RESULTS: Volume scores on non-ECG-gated CT correlated more strongly with ECG-gated CT scores than Agatston scores ( r = 0.95 vs. 0.69, P < 0.001). Bland-Altman analysis demonstrated substantial negative bias and proportional error for Agatston scores (mean difference, -921.1 units; limits of agreement, -2900.8 to +1058.6), while volume scores showed minimal bias and no proportional error (+16.5 mm 3 ; -648.5 to +681.4). Deming regression confirmed closer agreement for volume scores (slope, 1.02; R2 = 0.90). ROC analysis showed higher area under the curve values for volume scores (0.976 for men, 0.975 for women) than for Agatston scores (0.946 and 0.967, respectively).
CONCLUSION: Non-ECG-gated CT enables reliable quantification of aortic valve calcium in severe aortic stenosis. Volume scoring demonstrates superior agreement and diagnostic performance compared with Agatston scoring, supporting its use as a robust, density-independent metric for opportunistic assessment of AVC on routine chest CT.