Background-Recent studies demonstrated an influence of atherosclerotic risk factors on the progression of aortic valve stenosis. The extent of aortic valve calcification (AVC) was also found to be a strong predictor of stenosis progression. We investigated the influence of the LDL cholesterol level (LDL), other standard cardiovascular risk factors, and the extent of coronary calcification (CC) on the progression of AVC quantified by electron beam tomography (EBT). Methods and Results-In 104 patients (64.7Ϯ8 years, 89 male) with an EBT scan positive for AVC, CC and AVC were quantified using a volumetric score. EBT was repeated at a mean interval of 15 months (10 to 36 months), and the progression of AVC and CC was determined. Patients were divided into 2 groups according to LDL: group 1, LDLՅ3.36 mmol/L (130 mg/dL), 57 patients; group 2, LDLϾ3.36 mmol/L (130 mg/dL), 47 patients. Mean values for CC were 546Ϯ932 mm 3 in scan 1 and 665Ϯ1085 mm 3 in scan 2 for AVC 324Ϯ796 mm 3 and 404Ϯ1076 mm 3 , respectively. The mean progression of CC was 27Ϯ37% (group 1, 16Ϯ22%; group 2, 39Ϯ46%, PՅ0.001) and of AVC was 25Ϯ38% (group 1, 9Ϯ22%; group 2, 43Ϯ44%, PՅ0.001). Conclusions-Quantification of AVC by EBT permits new insights into the progression of aortic valve sclerosis. We observed a strong influence of LDL cholesterol level on the progression of AVC and CC, suggesting that lipid-lowering therapy may decrease the progression of aortic valve calcification.
Objective: To compare the presence and extent of coronary calcifications in young patients with first, unheralded acute myocardial infarction with matched controls without a history of coronary artery disease. Methods: In 102 patients under 60 years of age (19-59 years, mean 41 years; 88% male), electron beam tomography was done 1-14 days after acute myocardial infarction, before any coronary intervention. Coronary calcifications were quantified using the Agatston score. Age related calcium centiles were determined based on the Mayo Clinic "epidemiology of coronary calcification" study, and results were compared with a group of 102 controls without coronary artery disease, matched for sex, age, and risk factors. Results: Calcifications were present in 95.1% of patients with acute myocardial infarction and in 59.1% of controls (p = 0.008). The mean (SD) Agatston score was 529 (901) in the infarct patients versus 119 (213) in the controls (p < 0.001). An Agatston score above the 50th centile was present in 87.2% of infarct patients and 47.0% of controls (p = 0.006), and above the 90th centile in 60.7% of infarct patients and only 5.8% of controls (p = 0.001). Conclusions: In young patients with their first, unheralded acute myocardial infarction, the presence and extent of coronary calcium are significantly greater than in matched controls. E lectron beam tomography is a sensitive tool for detecting and quantifying coronary calcifications.1 The amount of coronary calcium correlates with the amount of coronary atherosclerotic plaque.2-5 Thus the presence and extent of coronary artery calcification has been shown to be associated with an individual's risk for cardiovascular events. [6][7][8][9][10][11][12] In up to 50% of patients who suffer an acute myocardial infarct, this event is the first clinical manifestation of coronary artery disease. 13 Recent studies have shown detectable coronary calcifications in 95% of patients with acute coronary syndromes.14 15 However, in younger individuals, coronary events often occur in the presence of early stages of coronary artery disease, presumably caused by the rupture of lipid-rich coronary plaques, [16][17][18] and coronary calcification may be less prevalent than in older patients with acute myocardial infarction. 19 The value of electron beam tomography in detecting relatively young patients at risk of acute myocardial infarction is therefore less clear and has so far not been investigated.Our aim in this study was to assess the prevalence and the extent of coronary calcification in younger patients with a first, unheralded acute myocardial infarct in comparison with matched controls without a history of coronary artery disease.
METHODS
Patients and controlsWe recruited 102 patients under 60 years of age with an unheralded, first transmural myocardial infarct established by ST elevation on the ECG and increased serum markers of myocardial damage (creatine kinase, creatine kinase MB isoenzyme, and troponin C). Patients with a previously established diagnosis of coronary ...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.