Coronary artery calcification correlates with the presence and severity of valve calcification

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Abstract

Aim

To investigate the prevalence of coronary artery calcification (CAC) in symptomatic individuals with CT evidence for left heart valve calcification, aortic valve (AVC), mitral valve (MAC) or both.

Methods

This is a retrospective study of 282 consecutive patients with calcification in either the aortic valve or mitral annulus. Calcium scoring of the coronary artery, aortic and mitral valve was measured using the Agatston score.

Results

AVC was more prevalent than MAC (64% vs. 2.5%, p < 0.001), with 34% having both. Absence of CAC was noted in 12.7% of the study population. AVC + CAC were observed in 53.5%, MAC and CAC in 2.1%, and combined AVC, MAC and CAC in 31.6%. The median CAC score was higher in individuals with combined AVC + MAC, followed by those with AVC and lowest was in the MAC group. The majority (40%) of individuals with AVC had CAC score > 400, and only in 16% had CAC = 0. The same pattern was more evident in individuals with AVC + MAC, where 70% had CAC score > 400 and only 6% had CAC score of 0. These results were irrespective of gender. There was no correlation between AVC and MAC but there was modest correlation between CAC score and AVC score (r = 0.28, p = 0.0001), MAC (r = 0.36, p = 0.0001) and with combined AVC + MAC (r = 0.5, p = 0.0001). AVC score of 262 had a sensitivity of 78% and specificity of 92% for the prediction of presence of CAC.

Conclusion

The presence and extent of calcification in the aortic valve or/and mitral valves are associated with severe coronary artery calcification.

Introduction

Many studies have investigated the prevalence and extent of calcification of the coronary artery and, to a lesser extent, of the aortic and mitral valve [1], [2], [3], [4], [5], [6], [7], [8], [9], [10]. Although a number of these studies have found a correlation between calcification of the coronary artery and aorta, few have investigated whether the prevalence and extent of valve calcification are too related to that of the coronary arteries. Since calcification of the coronary artery is a strong predictor of acute coronary syndrome and mortality and aortic valve calcification (AVC) is the most common cause of aortic stenosis in the developed countries, it would be important for patient management to determine whether the prevalence and extent of the one would also predict the other.

The aim of this study is to investigate the prevalence of coronary artery calcification (CAC) in individuals with CT evidence for AVC, mitral valve calcification (MAC) or of both of them (AVC + MAC).

Section snippets

Study population

Between August 2010 and September 2011 from the patients referred to European Scanning Centre, London, UK, for assessment of CAC score, we identified 282 consecutive patients with AVC, MAC or both. Medical history, demographic information and the presence of risk factors were abstracted from referral letters and questionnaires completed by the patients prior to the CT scan.

Patients with known history of coronary artery disease (CAD), prior intervention, surgery, valve disease, chronic kidney

Statistical analysis

Statistical analyses were carried out using a statistical package program (SPSS). Results of numerical data are presented as median, range. A p < 0.05 was considered statistically significant. AVC was assessed in a continuous fashion/way (AVC score). The same method was followed for MAC and the combined AVC + MAC. Also the CAC Score (CACS) was assessed in a continuous fashion and also in categories (0, 1–100, 101–400, 401–1000, and > 1000). The CACS, AVCS, MACS and the AVC + MAC score were log

Results

The study group consisted of 282 individuals with detectable valve calcification (AVC, MAC or AVC + MAC). The mean patients age was 67.1 ± 10.6 years old, while 176 (63.8%) were males. Family history of premature CAD was present in 53 (19.1%) of the cohort, 210 (75.3%) had hypercholesterolemia, 174 (63%) were hypertensive, 34 (12.3%) were diabetic and 32 (11.6%) were smokers.

The majority of individuals (63.8%) had isolated AVC, 33.7% had combined AVC + MAC and only 2.5% had isolated MAC. Absence of

Findings

Our results show that AVC is far more prevalent than MAC and that it is more common to find calcification of both valves than MAC alone. In a similar way, the prevalence of AVC combined with CAC was found most regularly, followed by calcification in all locations (AVC, MAC and CAC) with only a few patients having CAC + MAC. The median CACS was highest in individuals with combined AVC + MAC, followed by those AVC and finally with MAC. In a similar way, the valvular calcium burden was highest in

References (21)

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