Coronary artery disease (CAD) is the single biggest cause of cardiac morbidity and mortality, while calcific aortic valve stenosis (AVS) is the third-leading cause of cardiovascular disease, placing a major burden on healthcare systems throughout the world^[1,2]. CAD develops as a chronic process of atherosclerotic plaque formation with progressive luminal narrowing. The natural history of these plaques varies, but most will form and evolve over years to decades, with atheroma remodelling and calcification, before any symptoms develop. Similarly, AVS often develops and progresses silently and by the time symptoms are present, the prognosis is poor^[2].

The increasing number of CT chest examinations presents an opportunity to 'screen' a large number of asymptomatic individuals for coronary artery and aortic valve disease. A hallmark of both atherosclerotic CAD and AVS is the development of calcification. Indeed, the degree of coronary artery calcification (CAC) on CT is a well-validated marker of total coronary artery atherosclerotic burden^[2]. It has also been shown that CT measures of aortic valve calcification correlate with severity of aortic stenosis and can provide information beyond that which is available by echocardiography^[3]. The Agatston method for quantification of CAC on ECG-gated CT scans has been extensively validated and, more recently, a visual approach has been proposed for the quantification of CAC on non-ECG-gated studies^[4].

The aim of our study was to assess the incidence and severity of coronary artery and aortic valve calcification in middle-aged adults on non-ECG-gated CT chest. Secondly, we evaluated the correlation between the visual and Agatston score for coronary artery and aortic valve calcification. Additionally, we investigated whether these findings were mentioned in the CT reports.