Accurate assessment of aortic stenosis severity requires alignment between anatomical and functional valve measurements, yet discrepancies between modalities remain clinically relevant. In this analysis published in the International Journal of Cardiology, the relationship between computed tomography–derived geometric orifice area (GOA) and effective orifice area (EOA) from echocardiography and catheterization was evaluated, along with their association with hemodynamic factors and left ventricular load.

GOA was measured at peak systole using four-dimensional computed tomography planimetry, while EOA derived from echocardiography (EOAecho) and catheterization (EOAcathe) was calculated using the continuity and Gorlin equations. Associations, agreement, and bias were assessed using correlation analysis, Passing–Bablok regression, and Bland–Altman plots. Multivariable and hierarchical regression models evaluated determinants of EOA-to-GOA ratios and the incremental value of valve metrics for preprocedural N-terminal pro–B-type natriuretic peptide (NT-proBNP).

GOA demonstrated high reproducibility (intraclass correlation coefficient 0.95) and showed strong correlations with EOAecho (r=0.67) and EOAcathe (r=0.65), while agreement between EOAecho and EOAcathe was moderate (r=0.55). Stroke volume index significantly influenced EOA-to-GOA ratios. Only GOA provided a modest but statistically significant incremental explanatory value for NT-proBNP (ΔR²=0.03; p=0.02).

These findings support the complementary role of anatomical and functional valve assessments in characterizing aortic stenosis severity.