{"id":"e7fd2a2fa28b","type":"article","url":"https://hartvaat.nl/2026/08/14/hogere-hu-drempels-voegen-geen-waarde-toe-aan-ct-calciumscoring-voor-aortaklepst/","title":"Hogere HU-drempels voegen geen waarde toe aan CT-calciumscoring voor aortaklepstenose","title_en":"CT-based multi-threshold calcium scoring for aortic valve assessment: comparable predictive performance across HU thresholds in a pre-TAVI cohort.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"The international journal of cardiovascular imaging","doi":"10.1007/s10554-026-03800-y","source_url":"https://doi.org/10.1007/s10554-026-03800-y","authors":["Michael Welt","Mohammad Alnees","Yazan Hamdan","Khaled Khalilia","Tamar Shalmon","Jebrin Alkrinawi","Ramon Cohen","Mustafa Abu Teer","Elias Hellou","Nizar Abu Hamdeh","Amir Haim","Omar Ayyad","Adam Hasan","Mohammad Masu'd","Duha Najajra","Alex Blatt","Haitham Abu Khadija"],"significance":3,"published":"2026-08-22","source_date":"2026-08-14","image":"https://hartvaat.nl/global/img/7a234098d6e2.webp","kennis":["https://hartvaat.nl/kennis/kleplijden/aortastenose/","https://hartvaat.nl/kennis/diagnostiek/cardiale-ct-coronaire-calcium-score/"],"congress":"","summary_en":"In a single-center retrospective cohort of 63 patients with severe aortic stenosis, researchers evaluated whether higher Hounsfield unit (HU) thresholds for CT calcium scoring offer additional value beyond the conventional 130-HU Agatston method. While calcium scores at all thresholds correlated with transvalvular gradients, higher thresholds (up to 1000 HU) did not outperform the standard 130-HU scoring and showed only modest discrimination for very severe hemodynamic burden. These findings reinforce that the conventional 130-HU threshold remains sufficient for clinical aortic valve assessment, with higher thresholds serving only as complementary densitometric tools rather than alternative diagnostic cut-offs.","created":"2026-08-15T01:33:47Z","updated":"2026-08-15T01:33:49Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"In een retrospectieve single-center studie van 63 patiënten met ernstige aortaklepstenose werd onderzocht of hogere Hounsfield-eenheden (HU)-drempels voor CT-calciumscoring meerwaarde bieden boven de standaard 130-HU Agatston-score. De calciumscores bij alle drempels correleerden weliswaar met de transvalvulaire gradiënten, maar hogere drempels (tot 1000 HU) presteerden niet beter dan de conventionele score en discrimineerden slechts matig tussen patiënten met een zeer ernstige hemodynamische belasting. Voor de klinische praktijk bevestigt dit dat de standaard 130-HU-score voldoende is voor aortaklepassessment; hogere drempels kunnen eventueel complementair worden gebruikt, maar vervangen de conventionele scoring niet.","abstract_original":"To determine whether higher Hounsfield unit (HU) thresholds for computed tomography-derived aortic valve calcium (CT-AVC) scoring provide additional hemodynamic or discriminatory value beyond conventional 130-HU Agatston scoring in classical high-flow/high-gradient severe aortic stenosis (AS). This single-center retrospective cohort included 63 consecutive pre-TAVI patients with trileaflet, classical high-flow/high-gradient severe AS. CT-AVC was quantified on non-contrast ECG-gated CT at 130, 200, 500, 800, and 1000 HU within a manually defined leaflet/annulus region of interest, excluding left ventricular outflow tract and mitral annular calcification. Associations with peak gradient, mean gradient, and aortic valve area were assessed using correlation and multivariable linear regression.Exploratory ROC analysis assessed discrimination of very severe hemodynamic burden, defined as a mean gradient ≥ 60 mmHg, within the established severe-AS cohort, with ROC areas compared using DeLong testing. CT-AVC at all HU thresholds was independently associated with higher peak gradient (β, 0.010 at 130 HU to 0.144 at 1000 HU; all P ≤ 0.005) and higher mean gradient (β, 0.0059 at 130 HU to 0.073 at 1000 HU; all P ≤ 0.024). Associations with aortic valve area were not statistically significant. Within-cohort discrimination of very severe hemodynamic burden was modest and comparable across thresholds (AUC 0.65-0.67), with no statistically significant difference by DeLong testing (P = 0.68). In classical high-flow/high-gradient severe AS, CT-AVC demonstrated consistent associations with transvalvular gradients across HU thresholds. Higher HU thresholds did not outperform conventional 130-HU scoring and showed only modest, comparable performance for within-severity hemodynamic stratification. These thresholds should be interpreted as complementary densitometric analyses rather than alternative diagnostic cut-offs."}