March 12, 2025 – New research from Karl Landsteiner University of Health Sciences (KL Krems) in Austria provides important new insights into how aortic valve size is associated with the degree of valve calcification in severe aortic stenosis (AS).
Historically, the severity of AS has been assessed using aortic valve calcification (AVC) scores, which were interpreted differently for men and women due to observed differences in calcification levels between the sexes. However, research led by Professor Julia Mascherbauer, Head of the Department of Internal Medicine 3 at St. Pölten University Hospital (a KL Krems teaching and research center), offers new insights. It shows that when adjusting for valve size, the amount of calcification required to trigger severe AS was more directly linked to the size of the aortic valve annulus (the fibrous ring supporting the valve), rather than sex.
The study analyzed data from 601 patients with severe high-gradient AS who underwent cardiac CT scans. While it was found that women generally had smaller aortic valves and lower AVC scores, the correlation between AVC and valve size independent of sex was much stronger. This suggests that patients with smaller valves may be underdiagnosed or misclassified based on the current sex-specific diagnostic thresholds.
The key findings include:
- Valve size affects AVC levels: There was a significant association between the amount of calcification and the size of the aortic valve, regardless of sex.
- Misclassification risk: Individuals with smaller aortic valves were more likely to have severe AS despite having AVC scores that fell below current diagnostic cut-offs. This was observed in nearly one-third of both men and women with the smallest valves.
- Need for new diagnostic criteria: The study advocates for revising current AVC reference values to incorporate valve size. This could lead to more accurate diagnoses and prevent delays in treatment for patients, particularly those with smaller aortic valves.
The study emphasizes the importance of integrating valve size into clinical decision-making, potentially leading to more personalized diagnostic criteria for AS. This research could influence future clinical guidelines, improving the way severe aortic stenosis is assessed and ultimately leading to better patient outcomes.
The study was conducted by the Cardiology Department at St. Pölten University Hospital in collaboration with the Institute of Medical Radiology UK St. Pölten, and the Cardiology Departments of Medical University of Vienna and Paracelsus Medical University of Salzburg. It highlights the commitment of KL Krems to advancing clinical research that directly influences medical practice.