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. 2025 Jun;18(6):e017858.
doi: 10.1161/CIRCIMAGING.124.017858. Epub 2025 May 9.

Characterization of Aortic Valve Stenosis by CT Angiography in a Diverse US Cohort

Daniel Lorenzatti #  1 , Annalisa Filtz #  1 , Pamela Pina  2 , Jolien Geers  3 , Jake Gilman  1 , Jonathan Daich  1 , Paul Ippolito  1 , Abdullah Aftab  1 , Aldo L Schenone  1 , Carlos A Gongora  1 , Justin Johannesen  1 , Andrea Scotti  1 , Edwin C Ho  1 , Mario J Garcia  1 , Azeem Latib  1 , Carlos J Rodriguez  1 , Daniel S Berman  3 , Marie-Annick Clavel  4 , Philippe Pibarot  4 , Robert O Bonow  5 , Piotr J Slomka  6 , Marc R Dweck  7 , Damini Dey  6 , Leandro Slipczuk  1
Affiliations

Characterization of Aortic Valve Stenosis by CT Angiography in a Diverse US Cohort

Daniel Lorenzatti et al. Circ Cardiovasc Imaging. 2025 Jun.

Abstract

Background: Aortic stenosis (AS) involves calcific and fibrotic degeneration of the valve tissue. The only noninvasive method for evaluating both processes is contrast-enhanced computed tomography angiography. We aimed to explore the differences in aortic valve (AV) tissue composition across sex, race/ethnicity, and AS hemodynamic phenotype in US patients referred for transcatheter AV replacement planning.

Methods: We retrospectively analyzed symptomatic patients with AS who underwent computed tomography angiography for transcatheter AV replacement planning between 2015 and 2022. Using semi-automated software, we quantified the AV tissue composition by fibrotic, calcific, and fibro-calcific volumes, and the fibro-calcific ratio (fibrotic/calcific volume) as a measure of valve phenotype.

Results: The study included 651 patients (mean age 84 years; 55% women) with 38% non-Hispanic (NH)-White, 27% Hispanic, and 13% NH-Black. Women had lower fibro-calcific (230 versus 293 mm³/cm²; P<0.001) and calcific volumes (85 versus 149 mm³/cm²; P<0.001), and higher fibro-calcific ratio (1.47 versus 0.83; P<0.001). No differences were observed in the fibrotic volumes (P=0.805). NH-White women had higher fibro-calcific (256 mm³/cm², P=0.002) and fibrotic volumes (145 mm³/cm²; P<0.001), and fibro-calcific ratio (1.57; P=0.01) compared with Hispanic and NH-Black women. No differences were found among men. High-gradient AS had higher fibro-calcific (295 versus 219 mm3/cm2; P<0.001) and calcific volumes (148 versus 88 mm3/cm2; P<0.001), and a lower fibro-calcific ratio (0.90 versus 1.45; P<0.001), although no difference in fibrotic volume (P=0.099) compared with low-gradient AS.

Conclusions: Phenotypic differences in computed tomography angiography valve tissue composition exist in patients with AS referred for transcatheter AV replacement, with women and low-gradient AS showing a proportionally more fibrotic phenotype. NH-White women have the highest fibrotic tissue composition, and no differences are evident among men.

Keywords: aortic valve; aortic valve stenosis; computed tomography angiography; heart valve diseases; racial groups; sex.

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Conflict of interest statement

Drs Filtz, Lorenzatti, and Slipczuk are supported by institutional grants from Amgen and Philips. Dr Dey received grant support from the National Heart, Lung, and Blood Institute, software royalties from Cedars-Sinai Medical Center, and holds a patent (US8885905B2in USA and WO patent WO2011069120A1, Method and System for Plaque Characterization). Dr Ho reports consulting/advisory board relationships with GE, Philips, Edwards Lifesciences, Medtronic, Abbott. Dr Pibarot reports research contracts with Edwards Lifesciences, Novartis, Medtronic and Pi-Cardia. The other authors report no conflicts.

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