Intracardiac Calcification Is a Marker of Generalized Atherosclerosis

Abstract

Aortic valve calcification (AVC) and carotid artery calcification (CAC) are considered to be markers of generalized atherosclerosis. However, the role of intracardiac calcification (ICC) (valvular and perivalvular calcification) is unclear. The objective of this retrospective study was to analyze the relationship between ICC and CAC, risk factors, and clinical atherosclerotic disease. Risk factors included age, sex, diabetes mellitus, hypercholesterolemia, and hypertension; clinical atherosclerosis comprised stroke, coronary artery disease, and peripheral artery disease. Between January 1, 2001, and January 1, 2004, all consecutive patients were enrolled into the study who underwent both carotid ultrasonography and transthoracic echocardiography examinations within 2 months. Patients with renal failure, substantial aortic stenosis, and carotid artery occlusion were excluded. There were 320 patients (104 men; mean +/- SEM age, 66.6 +/- 0.76 years). Positive results on carotid ultrasonography are defined as any CAC. Patients were categorized as having mild, moderate, or severe CAC. Positive results on transthoracic echocardiography were defined as any ICC; AVC was defined as mitral anulus calcification (MAC) or both. Intracardiac calcification was found in 181 patients, AVC in 51 patients, MAC in 48 patients, and calcification of both structures in 82 patients. Using multiple logistic regression analysis, ICC (odds ratio, 1.9), age (10-year periods) (odds ratio, 2.0), and the presence of peripheral artery disease (odds ratio, 1.7) were independent predictors of CAC. Carotid ultrasonography results were positive in 227 patients. For CAC, the sensitivities of AVC, MAC, both, and any ICC were 52.4%, 52.0%, 33.5%, and 71.2%, respectively, and the specificities were 84.9%, 87.1%, 92.5%, and 78.5%, respectively. The extension of ICC as 0, 1 location (AVC or MAC) , or 2 locations (AVC and MAC) was associated with the severity of CAC (P < .001, tau = 0.42). There was no difference between patients with AVC vs patients with MAC in the presence of different stages of CAC (P = .62). Intracardiac calcification (MAC or AVC) is an independent predictor of CAC as a marker of atherosclerosis, although the lack of ICC does not rule out atherosclerosis. Intracardiac calcification is related to CAC, with high specificity. The extension of ICC is related to the severity of atherosclerosis. Based on our results, antiatherothrombotic therapy should be considered in patients with ICC even before obtaining a positive carotid ultrasonography result.

Aortic valve type and calcification as assessed by transthoracic and transoesophageal echocardiography

“…In asymptomatic AS, advanced AVC is a strong predictor of poor prognosis, with increased risk of death and aortic valve replacement (Rosenhek et al ., ). Moreover, numerous studies have shown an association between AVC and adverse clinical events (Rosenhek et al ., , ; Pohle et al ., ; Branch et al ., ; Nemcsik et al ., ; Palmiero et al ., ; Ishii et al ., ; Corciu et al ., ; Pradelli et al ., ). Recently, AVC assessment by TEE has been shown useful in transcatheter aortic valve implantation procedures for predicting postprocedural aortic regurgitation (Colli et al ., ; Koos et al ., ).…”

“…Aortic valve calcification (AVC) is considered an active disease process of the aortic valve associated with risk factors and molecular pathways that lead to disease progression and, eventually, complications (Otto, ). Moreover, AVC is a powerful predictor of adverse clinical events for patients with cardiac (Pohle et al ., ; Palmiero et al ., ; Corciu et al ., ; Pradelli et al ., ) and vascular diseases (Rossi et al ., ), and in the general population (Rosenhek et al ., , ; Pohle et al ., ; Branch et al ., ; Nemcsik et al ., ; Palmiero et al ., ; Ishii et al ., ; Corciu et al ., ). AVC has also been recognized as a risk factor for complications after transcatheter aortic valve implantations (Colli et al ., ; Koos et al ., ).…”

Prognostic value of heart valve calcifications for cardiovascular events in a lung cancer screening population

“…Large calcifications of the aortic valve for example, may lead to impaired leaflet function followed by heart failure [ 30 ]. Calcifications of the mitral annulus are part of a chronic non-inflammatory degenerative process [ 32 ], and severe calcifications of the mitral annulus may cause mitral regurgitation [ 31 ]. Therefore, cardiac valve calcifications should be reported in the clinical radiology routine where individual risk factors may be unknown [ 33 , 34 ].…”

Structural and functional changes of the myocardium and heart valves in patients of advanced and senile age with coronary pathology

“…В последние годы этой патологии уделяется особое внимание, что обусловлено не только негативным влиянием прогрессирующего кальциноза на гемодинамические характеристики клапана. В ряде исследований показано, что кальциноз аортального клапана связан с сердечно-сосудистым риском, наличием сахарного диабета и системного атеросклероза [15][16][17][18]. В этой связи обсуждается общность патогенетических механизмов кальциноза аортального клапана с атеросклерозом сосудов [19,20].…”