Aortic valve calcium seen by chance on a CT scan

The main guidance

BSCI/BSCCT and BSTI consensus (UK, 2021): review the heart on every CT where it is seen; if aortic valve calcium is present, grade it as none, mild, moderate or severe (recommendation 4), and also check the width of the aortic root and the aorta just above the heart (recommendation 5). (BSCI/BSTI 2021)
Suggested report text: "Moderate/Severe aortic valve calcification. This may indicate the presence of aortic valve stenosis. Consider echocardiography if clinically appropriate." (BSCI/BSTI 2021)
NICE NG208 (UK, 2021): bases the echocardiogram decision on a heart murmur found when a doctor listens to the chest, with age (especially over 75) and history as factors; it does not mention calcium seen on a CT. (NICE NG208)

Who it applies to

Adults who had a chest CT for another reason, such as a lung problem or a lung cancer screening scan. It is common: one hospital study found aortic valve calcium on 18% of chest CT scans. (Koos 2006) The UK consensus says moderate or severe aortic stenosis is reported in about 5% of people over 75, and that wear and calcium build-up on the valve is its leading cause. (BSCI/BSTI 2021) MedlinePlus says heart valve disease is more likely with age, as the valves can become thick and stiff. (MedlinePlus)

How it is graded on a chest CT

Aortic valve calcium grades on a chest CT and what the UK consensus suggests (simplified)
Visual grade	What the UK consensus says
None	No calcium on the valve
Mild	Importance uncertain and more evidence needed; the exception is a bicuspid valve, which can narrow with only mild calcium
Moderate	May indicate aortic stenosis; consider echocardiography if clinically appropriate
Severe	May indicate aortic stenosis; consider echocardiography if clinically appropriate

The consensus chose a simple visual grade because a full calcium score on a routine CT takes dedicated software and training. It also says calcium on the valve must be told apart from calcium in the aortic root, the mitral valve ring or the heart arteries. (BSCI/BSTI 2021)

What usually comes next

Moderate or severe calcium: it may identify people who need more assessment, such as an echocardiogram (a heart ultrasound that shows how well the valve opens). In many people the valve disease is already known and an echocardiogram has already been done. (BSCI/BSTI 2021)
A wide aorta on the same scan: the consensus says it is not an immediate reason to be recalled for a contrast scan, but should prompt a closer look at the valve and possibly the aorta. See wide chest aorta found by chance. (BSCI/BSTI 2021)
Symptoms: the consensus notes valve calcium may be the cause of breathlessness. (BSCI/BSTI 2021) The NHS says that if you have symptoms of heart valve disease a GP will listen to your heart and may arrange an echocardiogram, an ECG or a chest X-ray. (NHS)

How it differs from heart artery calcium

The same scan may also show calcium in the heart (coronary) arteries. The UK consensus says that finding is a marker of heart artery disease and usually leads to a review of heart risk factors, with no more imaging for people without symptoms. (BSCI/BSTI 2021) Valve calcium is about the valve itself, and moderate or severe calcium may lead to an echocardiogram instead. (BSCI/BSTI 2021) For the artery finding, see heart artery calcium found by chance on chest CT and coronary calcium score results.

If you are younger

A study found valve calcium appeared about 14 years earlier in people born with a two-leaflet (bicuspid) aortic valve, was more often severe, and was more strongly linked to stenosis. The authors suggest valve calcium found before the seventh decade be considered a marker for a bicuspid valve. (Hope 2012) See screenings if you have a bicuspid aortic valve.

What the finding does and does not show

The grade on a CT tracks how narrowed the valve is on an echocardiogram, but is not the same test: in one study 60% of people with the two highest grades had stenosis, compared with 2.4% of those with lower grades. (Koos 2006)
It is often left out of reports: in a UK survey, 22% of radiologists said they do not report aortic valve calcium. (BSCI survey 2022) If your report does not mention the heart, you can ask your doctor whether it was reviewed.

NHS, when to get help for possible heart valve symptoms: (NHS)

See a GP if:

you're feeling short of breath regularly
you feel tired, weak or dizzy when doing normal activities
you have heart palpitations that keep coming back, last longer than a few minutes or are getting worse
you have swollen ankles or feet
you have chest pain that comes and goes

Call 999 or go to A&E if:

you're struggling to breathe
you have sudden chest pain that spreads to your arms, back, neck or jaw, or lasts more than 15 minutes
you have chest pain with shortness of breath or heart palpitations

In the US, the emergency number is 911.

Routine age-based screening

A finding on a scan does not replace the routine screenings for your age, such as blood pressure checks. See heart screenings by age.

Where they differ:

What triggers an echocardiogram. The UK radiology consensus suggests considering one for moderate or severe valve calcium on a CT. (BSCI/BSTI 2021) NICE NG208 bases it on a heart murmur and does not cover CT findings. (NICE NG208) The NHS describes an echocardiogram after a GP hears signs or symptoms. (NHS)
Mild calcium. The UK consensus calls its importance uncertain. (BSCI/BSTI 2021) A US study of lung cancer screening scans in veterans found more valve calcium was linked to a higher risk of death, heart attack and stroke over 4 years, even after excluding severe stenosis. (Christensen 2020)
Reporting in practice. The consensus recommends reporting it on every chest CT, but a survey found radiologists who are not heart imaging specialists were less likely to report it or to suggest an echocardiogram. (BSCI/BSTI 2021)(BSCI survey 2022)

Your doctor decides what your result means for you.

Questions people ask

Does aortic valve calcium mean I have aortic stenosis?

Not always. The UK consensus says moderate or severe valve calcium may indicate a narrowed valve (aortic stenosis), and that the meaning of mild calcium is uncertain. In one study, 60% of people with the two highest grades had stenosis on an echocardiogram, compared with 2.4% of those with lower grades. (BSCI/BSTI 2021) (Koos 2006)

How common is it?

Common. In one hospital study it was seen on 18% of chest CT scans. MedlinePlus says heart valve disease is more likely as you get older, because the valves can become thick and stiff. (Koos 2006) (MedlinePlus)

Will I need an echocardiogram?

The UK consensus suggests the report for moderate or severe valve calcium say to consider an echocardiogram (a heart ultrasound) if clinically appropriate. It notes many people already have known valve disease or a recent echocardiogram. Your doctor decides. (BSCI/BSTI 2021)

How is this different from calcium in the heart arteries?

The UK consensus treats them differently. Heart artery calcium usually leads to a review of heart risk factors, not more scans. Moderate or severe valve calcium may lead to an echocardiogram to look at how the valve opens. (BSCI/BSTI 2021)

I am under 60. Does that change anything?

A study found valve calcium appeared about 14 years earlier in people born with a two-leaflet (bicuspid) valve, and suggests it be considered a marker for one when found before the seventh decade. The UK consensus says a bicuspid valve can narrow even with mild calcium. (Hope 2012) (BSCI/BSTI 2021)