March 3, 2026

Diagnostic performance of aortic valve calcium scoring for severe aortic stenosis in patients with chronic kidney disease

Puntos clave

Aortic valve calcium scoring effectively identifies severe aortic stenosis in chronic kidney disease patients, enhancing diagnostic precision.
The study highlighted that patients with higher calcium scores are more likely to have severe aortic stenosis, demonstrating a strong correlation between these factors.

PICO estructurado

Does chronic kidney disease affect the diagnostic accuracy of aortic valve calcium scoring for severe aortic stenosis?

Población

2,909 adults who underwent aortic valve calcium scoring and echocardiography across Mayo Clinic sites, stratified by eGFR (CKD vs non-CKD cohorts).

Intervención

Aortic valve calcium scoring (AVCS) via noncontrast Computed Tomography (CT)

Comparador

Patients with preserved renal function compared to patients with worsening chronic kidney disease (eGFR <60, <45, and <30)

Resultado

Diagnostic accuracy (Area Under the Curve [AUC] from ROC curves) for severe aortic stenosissurrogate

While aortic valve calcium scoring remains sensitive for ruling out severe aortic stenosis in patients with chronic kidney disease, its specificity significantly declines with worsening renal function, increasing the risk of false positives.

Resumen

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.

Me gusta

Guardar