European heart journal. Cardiovascular Imaging · 2026
Differential roles of calcification and fibrosis in aortic stenosis: a sex- and morphology-specific CT analysis.
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Shu Jun, Wen Didi, Xu Jingji, Zhang Jing, Xu Ziliang, Zhao Yao, Li Shuangxin, Meng Xiaoli, Li Zhuofan, Lv Zhuojie, Zheng Minwen
Аннотация
AIMS: Aortic stenosis (AS) is characterized by fibrotic and calcific remodelling of the valve, but their sex- and morphology-specific contributions to disease severity remain incompletely characterized.
METHODS AND RESULTS: This cross-sectional analysis enrolled 448 AS patients with preserved flow (left ventricular ejection fraction ≥50%, stroke volume index >35 mL/m²) who underwent comprehensive echocardiography and cardiac CT, severity was classified by both peak aortic jet velocity and indexed aortic valve area (AVA), and stratified by sex and valve morphology [bicuspid (BAV) or tricuspid (TAV) aortic valve]. Mean age was 64.6 ± 10.1 years, 48.2% were female, and 54.5% had BAV. Calcification metrics showed consistent, significant correlations with peak aortic jet velocity (e.g. Calcificvolumedensity: R = 0.571, P < 0.001) and indexed AVA (R = -0.466, P < 0.001) across all subgroups. In contrast, fibrotic volume density demonstrated minimal or non-significant correlations with severity indices and lacked a proportional association across severity stages. Pronounced sex- and morphology-specific patterns were observed. Specifically, in severe AS classified by both peak aortic jet velocity and indexed AVA, women with BAV had higher fibrotic volume density than men (P = 0.017 and 0.062), while men exhibited greater calcification (Both P < 0.001). Among TAV patients, men had higher calcific volume density (Both P < 0.001) and similar fibrotic volume density (P = 0.792 and 0.923) than women.
CONCLUSION: Valvular calcification is the tissue component more strongly and consistently associated with disease severity in AS, irrespective of whether assessed by peak aortic jet velocity or indexed AVA. Fibrosis represents a distinct phenotypic feature, particularly prominent in women with BAV.
METHODS AND RESULTS: This cross-sectional analysis enrolled 448 AS patients with preserved flow (left ventricular ejection fraction ≥50%, stroke volume index >35 mL/m²) who underwent comprehensive echocardiography and cardiac CT, severity was classified by both peak aortic jet velocity and indexed aortic valve area (AVA), and stratified by sex and valve morphology [bicuspid (BAV) or tricuspid (TAV) aortic valve]. Mean age was 64.6 ± 10.1 years, 48.2% were female, and 54.5% had BAV. Calcification metrics showed consistent, significant correlations with peak aortic jet velocity (e.g. Calcificvolumedensity: R = 0.571, P < 0.001) and indexed AVA (R = -0.466, P < 0.001) across all subgroups. In contrast, fibrotic volume density demonstrated minimal or non-significant correlations with severity indices and lacked a proportional association across severity stages. Pronounced sex- and morphology-specific patterns were observed. Specifically, in severe AS classified by both peak aortic jet velocity and indexed AVA, women with BAV had higher fibrotic volume density than men (P = 0.017 and 0.062), while men exhibited greater calcification (Both P < 0.001). Among TAV patients, men had higher calcific volume density (Both P < 0.001) and similar fibrotic volume density (P = 0.792 and 0.923) than women.
CONCLUSION: Valvular calcification is the tissue component more strongly and consistently associated with disease severity in AS, irrespective of whether assessed by peak aortic jet velocity or indexed AVA. Fibrosis represents a distinct phenotypic feature, particularly prominent in women with BAV.