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Updated: Nov 26, 2025
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Prevalence and clinical implications of valvular calcification on coronary computed tomography angiography
Michelle C Williams1,2, Daniele Massera3, Alastair J Moss1
1University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor's Building, 49 Little France Crescent, Edinburgh EH164SB, UK.
Insights
Aortic and mitral valve calcification are common in patients with stable chest pain undergoing coronary computed tomography angiography (CCTA). While valvular calcification indicates higher cardiovascular risk, it is not independent of coronary artery disease burden.
Area of Science:
- Cardiology
- Radiology
- Preventive Medicine
Background:
- Valvular heart disease, identified by calcification on coronary computed tomography angiography (CCTA), is linked to adverse clinical outcomes.
- Assessing aortic and mitral valve calcification is crucial for understanding cardiovascular risk in patients with stable chest pain.
Purpose of the Study:
- To evaluate the prevalence of aortic and mitral valve calcification in patients with stable chest pain undergoing CCTA.
- To determine the association of valvular calcification with cardiovascular risk factors, coronary artery disease (CAD), and cardiovascular outcomes.
Main Methods:
- 1769 patients undergoing CCTA for stable chest pain were analyzed.
- Aortic and mitral valve calcification were quantified using the Agatston score.
- Associations with risk factors, coronary artery calcium scores, obstructive CAD, and cardiovascular events were assessed.
Main Results:
- Aortic valve calcification (14%) and mitral valve calcification (4%) were present in patients with stable chest pain.
- Independent predictors for aortic valve calcification included age, male sex, hypertension, diabetes mellitus, and cerebrovascular disease.
- Patients with valvular calcification had higher coronary artery calcium scores and more obstructive CAD, with increased cardiovascular events, though not independently.
Conclusions:
- Aortic and mitral valve calcification are observed in approximately 16% of patients with stable chest pain undergoing CCTA.
- Valvular calcification is associated with concurrent coronary atherosclerosis and an increased risk of cardiovascular events.
- The increased cardiovascular risk associated with valvular calcification is not independent of the severity of underlying coronary artery disease.
Aims:
Valvular heart disease can be identified by calcification on coronary computed tomography angiography (CCTA) and has been associated with adverse clinical outcomes. We assessed aortic and mitral valve calcification in patients presenting with stable chest pain and their association with cardiovascular risk factors, coronary artery disease, and cardiovascular outcomes.
Methods And Results:
In 1769 patients (58 ± 9 years, 56% male) undergoing CCTA for stable chest pain, aortic and mitral valve calcification were quantified using Agatston score. Aortic valve calcification was present in 241 (14%) and mitral calcification in 64 (4%). Independent predictors of aortic valve calcification were age, male sex, hypertension, diabetes mellitus, and cerebrovascular disease, whereas the only predictor of mitral valve calcification was age. Patients with aortic and mitral valve calcification had higher coronary artery calcium scores and more obstructive coronary artery disease. The composite endpoint of cardiovascular mortality, non-fatal myocardial infarction, or non-fatal stroke was higher in those with aortic [hazard ratio (HR) 2.87; 95% confidence interval (CI) 1.60-5.17; P < 0.001] or mitral (HR 3.50; 95% CI 1.47-8.07; P = 0.004) valve calcification, but this was not independent of coronary artery calcification or obstructive coronary artery disease.
Conclusion:
Aortic and mitral valve calcification occurs in one in six patients with stable chest pain undergoing CCTA and is associated with concomitant coronary atherosclerosis. Whilst valvular calcification is associated with a higher risk of cardiovascular events, this was not independent of the burden of coronary artery disease.
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