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Author Spotlight: Advancing Cardiovascular Imaging - Introducing the Spatially Weighted Calcium Score for Early Disease Detection
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Author Spotlight: Advancing Cardiovascular Imaging - Introducing the Spatially Weighted Calcium Score for Early Disease Detection

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Computed tomography-derived score as a predictor of major adverse cardiovascular events in patients with severe

Maria Teresa Savo1, Valeria Pergola1, Morena De Amicis2

  • 1Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy.

Progress in Cardiovascular Diseases
|January 16, 2026
PubMed

Insights

The New Total Calcium (NTC) score accurately predicts outcomes in severe aortic stenosis patients undergoing transcatheter aortic valve replacement (TAVR). This comprehensive calcification assessment offers valuable risk stratification for improved patient management.

Area of Science:

  • Cardiovascular Imaging and Intervention
  • Cardiac Computed Tomography (CCT)
  • Aortic Stenosis (AS) Management

Background:

  • Prognostic significance of global calcium burden (coronary artery, mitral annular, aortic valve, thoracic aorta) in severe AS patients undergoing AVR is not fully understood.
  • Cardiac computed tomography (CCT) is used for calcification assessment.
  • Severe aortic stenosis (AS) requires intervention, often aortic valve replacement (AVR).

Purpose of the Study:

  • To evaluate the prognostic impact of overall calcification burden in patients with severe AS undergoing AVR.
  • To develop and validate a comprehensive scoring system for global calcium burden.

Main Methods:

  • Retrospective analysis of 313 severe AS patients undergoing CCT before AVR (2016-2019).
  • Quantification of mitral annular calcification (MAC), coronary artery calcification (CAC), aortic valve calcification (AVC), and development of a total thoracic aortic (TTA) score.
  • Integration of MAC, CAC, AVC, and TTA into a New Total Calcium (NTC) score using Random Forest models; 60-month follow-up for MACE, all-cause mortality, and non-cardiovascular mortality.

Main Results:

  • The study included 313 patients (mean age 81 years), with 93% undergoing transcatheter AVR (TAVR).
  • The TTA score predicted MACE, all-cause mortality, and non-cardiovascular mortality (p<0.05).
  • The NTC score demonstrated high prognostic accuracy for MACE at 1, 2, and 3 years (AUC 0.91, 0.80, 0.81), validated in an external cohort.

Conclusions:

  • The New Total Calcium (NTC) score is a promising tool for risk stratification in severe AS patients, particularly in the TAVR population.
  • Comprehensive calcification assessment using the NTC score can aid in predicting outcomes.
  • Further validation in surgical AVR (SAVR) populations is warranted.
Abstract

Keywords:
Aortic stenosisBurden calcificationCardiovascular outcomeNew Total Calcium scoreThoracic calcification

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