Aortic Valve Calcium Scoring Is Not Indicated in Your Case
Based on current guidelines, aortic valve calcium CT scanning is specifically reserved for situations where echocardiography shows conflicting or uncertain data about stenosis severity—not for screening when no stenosis exists. 1 Your recent echocardiograms clearly state "no stenosis," which means there is no diagnostic uncertainty requiring CT calcium scoring.
Why AV Calcium Scoring Is Not Appropriate Here
The Specific Indications Are Narrow
Aortic valve calcium scoring by CT is recommended only when echocardiography shows conflicting measurements in these specific scenarios: 1
- Low-flow, low-gradient AS with reduced ejection fraction
- Paradoxical low-flow, low-gradient AS with preserved ejection fraction (AVA <1.0 cm², mean gradient <40 mmHg, LVEF ≥50%, stroke volume index <35 mL/m²)
- Normal-flow, low-gradient AS (AVA <1.0 cm², mean gradient <40 mmHg, stroke volume index ≥35 mL/m²)
None of these apply to you—your echocardiograms document no stenosis, which means no valve area restriction and no pressure gradients across the valve. 1
Coronary and Valvular Calcification Are Separate Processes
Coronary artery calcification and aortic valve calcification are distinct disease processes that occur independently and should not be conflated. 1 Your LAD calcium score of 94 reflects coronary atherosclerosis, but this does not predict or indicate aortic valve calcification requiring measurement. 2
What Your Findings Actually Mean
Your Coronary Calcium Score
A CAC score of 94 in the LAD indicates mild coronary atherosclerosis and automatically elevates your cardiovascular risk category. 3, 4 This warrants:
- Statin therapy initiation (moderate-to-high intensity) with LDL-C goal <100 mg/dL, ideally <70 mg/dL 3
- Aggressive cardiovascular risk factor modification including blood pressure control, diabetes screening, and lifestyle interventions 3, 4
- Consideration of aspirin therapy if your 10-year cardiovascular risk exceeds 10% and blood pressure is controlled 3
Your Aortic Valve Status
The evolution from "sclerotic" 5 years ago to "no stenosis" currently suggests: 2
- Aortic sclerosis (thickening/calcification without obstruction) may have been present initially
- Serial echocardiography confirms no progression to stenosis, which is reassuring
- Repeat echocardiography every 3-5 years is appropriate to monitor for any future development of stenosis 1
Aortic sclerosis is associated with approximately 50% increased cardiovascular risk and may serve as a marker for coexisting coronary disease—which you have documented with your CAC score. 2 However, the absence of stenosis means no CT calcium scoring is warranted.
Important Caveats
Do not pursue AV calcium scoring based on coronary calcification alone. The presence of coronary calcium does not create an indication for valve calcium measurement when echocardiography clearly shows no stenosis. 1 This would represent inappropriate use of imaging resources and unnecessary radiation exposure.
Focus your management on the documented coronary atherosclerosis with aggressive lipid management, blood pressure control, and antiplatelet therapy as appropriate. 1 Continue routine echocardiographic surveillance every 3-5 years to monitor the aortic valve. 1