The purpose of this study was to assess whether the degree of fluoroscopic aortic valve calcification could help identify the presence of aortic stenosis in the elderly. To evaluate the diagnostic utility of cardiac fluoroscopy for the detection of aortic stenosis (aortic valve area less than or equal to 1.0 cm 2) in patients 60 years or older, aortic valve area determined by cardiac catheterization was related to the pattern of calcification seen on cinefluoroscopy in 97 patients (mean age of 72 +/- 6 years) with suspected aortic stenosis. Dense circumferential (3+) calcification of the aortic valve was seen on cinefluoroscopy in 56 of 59 patients with an aortic valve area less than or equal to 1.0 cm 2 (sensitivity 95%), compared to 5 of 38 patients with aortic valve area greater than 1.0 cm2 (specificity 87%) (p less than .001). These findings suggest that in patients 60 years of age or older with suspected aortic stenosis, a dense circumferential (3+) aortic valve calcification on cinefluoroscopy is highly predictive of an aortic valve area less than or equal to 1.0 cm2 with a positive predictive accuracy of 91% and a negative predictive accuracy of 91%. Thus cinefluoroscopy may provide an accurate adjunct or alternative to Doppler echocardiography in the assessment of aortic stenosis in the elderly.