The role of aortic valve calcium in the detection of aortic stenosis: an echocardiographic study.

One hundred fifty-three men (mean age 67.0 +/- 10.0 years) with basal systolic murmurs and aortic valve calcium on the echocardiogram (group II) were studied to assess the relationship between the grade of calcium and severity of aortic valve obstruction. Patients were subdivided into group IIA (hypertension, no coronary artery disease), group IIB (coronary artery disease, no hypertension), group IIC (hypertension and coronary artery disease) and group IID (neither hypertension nor coronary artery disease). Group I consisted of 21 normal age-matched men (mean age 60.5 +/- 10.9 years). Aortic valve calcium was graded as 1+ (63 patients), 2+ (54 patients), or 3+ (36 patients) according to the degree of involvement. Left ventricular wall thickness was greater in group II than in group I, and close correlation between wall thickness parameters and grade of aortic valve calcium was observed for group IID. Of 31 catheterized patients, none of seven with 1+ aortic calcium and 11 of 14 with 3+ calcium had gradients greater than or equal to 50 mm Hg. With 3+ calcium the valve area was 0.8 +/- 0.4 cm2, and with 1+ calcium it was 2.8 +/- 0.7 cm2 (f = 0.0006). The presence of 3+ calcium or grade 2+ calcium combined with a left ventricular ejection time index greater than 433 msec and a left ventricular mass greater than 300 gm was highly suggestive of severe aortic stenosis and could be used to separate patients to be considered for invasive studies from those with benign aortic valve sclerosis.