Cardiovascular Calcification as a Marker of Increased Cardiovascular Risk and a Surrogate for Subclinical Atherosclerosis: Role of Echocardiography

Abstract

The risk prediction of future cardiovascular events is mainly based on conventional risk factor assessment by validated algorithms, such as the Framingham Risk Score, the Pooled Cohort Equations and the European SCORE Risk Charts. The identification of subclinical atherosclerosis has emerged as a promising tool to refine the individual cardiovascular risk identified by these models, to prognostic stratify asymptomatic individuals and to implement preventive strategies. Several imaging modalities have been proposed for the identification of subclinical organ damage, the main ones being coronary artery calcification scanning by cardiac computed tomography and the two-dimensional ultrasound evaluation of carotid arteries. In this context, echocardiography offers an assessment of cardiac calcifications at different sites, such as the mitral apparatus (including annulus, leaflets and papillary muscles), aortic valve and ascending aorta, findings that are associated with the clinical manifestation of atherosclerotic disease and are predictive of future cardiovascular events. The aim of this paper is to summarize the available evidence on clinical implications of cardiac calcification, review studies that propose semiquantitative ultrasound assessments of cardiac calcifications and evaluate the potential of ultrasound calcium scores for risk stratification and prevention of clinical events.

Echocardiographic Advances in Dilated Cardiomyopathy

“… Pulse cancellation ultrasound technique (eSCAR). The echo machine built-in setting for LV opacification used without CE, thanks to cancellation of “linear” signals back from normal myocardium, is incidentally very efficient to enhance signals from abnormal myocardial tissue, such as fibrotic [ 167 ] and calcific tissues [ 168 ], which on the contrary show “nonlinear” response. This technique is able not only to provide a semi-quantitative identification of MF (number of scarred segments), but also to simply define a binary response “scar: yes/no” by the use of the software binary filter (“default” thresholding method) [ 167 ].…”

Emerging Roles of Circular RNAs in Vascular Smooth Muscle Cell Dysfunction

“…Atherosclerosis is the major pathophysiological basis of cerebrovascular and cardiovascular diseases and can be attributed to the interactions of a myriad of risk factors ( Wang et al, 2021a ; Qi et al, 2021 ; Xuan et al, 2021 ). With the increasing ageing population in most developed countries, the mortality and morbidity of cardiovascular and cerebrovascular diseases are growing worldwide ( Birger et al, 2021 ; Faggiano et al, 2021 ; Nasir and Cainzos-Achirica, 2021 ). Vascular smooth muscle cells (VSMCs) constitute the main structure of the vasculature and are key to the maintenance of vascular tone and blood pressure ( Zhang et al, 2014 ; Cil et al, 2021 ; Zhu et al, 2021 ).…”

Mitral Annular Calcification Detected by Transthoracic Echocardiography is a Marker for High Prevalence and Severity of Angiographically Proven Coronary Artery Disease

“…[13] Echocardiography is a low cost, portable, facile and radiation-free technique with obvious potential to detect and quantify vascular and valvular calcifications. [14] Pathologic studies have shown that in people between the ages of 13 and 39 foam cells were observed on the endothelium of the epicardial coronary arteries, [15] on the ventricular surface of the posterior mitral leaflet and on the aortic aspects of each of the aortic valve cusps. These collections of foam cells represent early atherosclerotic lesions, suggesting that coronary atherosclerosis, MAC, and calcium deposits of-aortic valve in the elderly have a similar etiology.…”