Coronary artery calcification correlates with the presence and severity of valve 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)
- et al.
Electron beam computed tomography evidence of aortic calcification as an independent determinant of coronary artery calcification
J Chin Med Assoc
(2006) - et al.
Combined presence of aortic valve calcification and mitral annular calcification as a marker of the extent and vulnerable characteristics of coronary artery plaque assessed by 64-multidetector computed tomography
Atherosclerosis
(2010) - et al.
Prediction of coronary events with electron beam computed tomography
J Am Coll Cardiol
(2000) - et al.
Coronary calcium and cardiovascular event risk: evaluation by age- and sex-specific quartiles
Am Heart J
(2002) - et al.
Coronary artery calcium evaluation by electron beam computed tomography and its relation to new cardiovascular events
Am J Cardiol
(2000) - et al.
Valvular and thoracic aortic calcium as a marker of the extent and severity of angiographic coronary artery disease
Am Heart J
(2003) - et al.
Quantification of coronary artery calcium using ultrafast computed tomography
J Am Coll Cardiol
(1990) - et al.
Association of aortic valve calcification to the presence, extent and composition of coronary artery plaque burden: from the Rule Out Myocardial Infarction using Computer Assisted Tomography (ROMICAT) trial
Am Heart J
(2009) - et al.
Relationship of aortic valve calcification with coronary artery calcium severity: the Multi-Ethnic Study of Atherosclerosis (MESA)
J Cardiovasc Comput Tomogr
(2010) - et al.
Relation of mitral annular calcium and coronary calcium (from the Multi-Ethnic Study of Atherosclerosis [MESA])
Am J Cardiol
(2011)
Cited by (22)
Outcome of Patients With Severe Aortic Stenosis and Normal Coronary Arteries Undergoing Transcatheter Aortic Valve Implantation
2021, American Journal of CardiologyCitation Excerpt :It is conceivable that these hypothetical pathophysiological factors are triggered by a different set or a different combination of cardiovascular risk factors as could be observed in patients with normal versus atherosclerotic coronary arteries in this study. In line with this interpretation, only weak to modest correlations between calcific AS and coronary, carotid and aortic atherosclerosis were observed in other studies;25-28 furthermore, cholesterol-lowering therapies failed to halt the progression of AS in randomized trials.29-31 Mortality rates of patients with severe AS and normal coronary arteries tended to separate at 30 days after TAVI from those with severe AS and coronary atherosclerosis, with significant differences observed at 1 year.
Associations of Mitral and Aortic Valve Calcifications with Complex Aortic Atheroma in Patients with Embolic Stroke of Undetermined Source
2018, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :Calcification of cardiac valves, including mitral annular calcification (MAC), aortic annular calcification (AAC), and aortic valve sclerosis (AVS), is considered to be a manifestation of generalized atherosclerosis.5 Indeed, several previous studies reported that these left-sided valve calcifications were associated with atherosclerosis in coronary arteries,6,7 carotid arteries,8 and aortic arch.9,10 Therefore, we hypothesized that mitral and aortic valve calcifications, both of which can be noninvasively assessed by transthoracic echocardiography (TTE), are good markers for predicting the presence of CAA among patients with ESUS.
Aortic root, not valve, calcification correlates with coronary artery calcification in patients with severe aortic stenosis: A two-center study
2015, AtherosclerosisCitation Excerpt :While CAC measurements are recommended for better risk stratification of patients at intermediate risk for CAD [18], AVC does not play a routine clinical role. AVC score has been shown to correlate with CAC score in insignificant aortic valve pathology [6,19–21], but the relationship between the two in patients with significant AS is far less studied, despite its impact for the transcatheter aortic valve implantation (TAVI) procedure [22]. Of mention, aortic root calcification (ARC) in AS patients, although frequently seen on echocardiography, has never been formally quantified in the context of calcified cardiac structures [4,23].
The relationship between coronary artery calcium score and the long-term mortality among patients with minimal or absent coronary artery risk factors
2015, International Journal of CardiologyCitation Excerpt :However, the FRS and the newer Atherosclerotic Cardiovascular Disease (ASCVD) Risk Prediction model [2] are heavily weighted by age and can inaccurately estimate the risk of CVD, especially in younger individuals and those at low risk of CVD. Coronary artery calcium (CAC) is a marker of coronary artery disease and associated with other conditions in calcium deposits [3,4]. CAC is a robust predictor of CVD events [5,6] and all-cause mortality [7,8] for individuals with an intermediate CVD risk [1,9,10].
A two center 320 slice CT study for evaluating coronary arteries in subjects with chronic atrial fibrillation: A comparison of prospective and retrospective ECG-gating acquisition
2014, International Journal of CardiologyCitation Excerpt :Recent developments in multislice computed tomography (CT) (MSCT) have been dramatic. This modality can achieve visualization of the lumen of coronary arteries [1–4] as well as plaque characteristics [5–7]. Many previous studies have shown that this modality has high sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) for detection of significant stenosis in coronary arteries confirmed by invasive coronary angiography (ICA), if the subjects have normal sinus rhythm with low heart rates (HR) [1,2].