Relation of Aortic Valve Calcium Detected by Cardiac Computed Tomography to All-Cause Mortality

Blaha, Michael J.; Budoff, Matthew J.; Rivera, Juan J.; Khan, Atif; Santos, Raul D.; Shaw, Leslee J.; Raggi, Paolo; Berman, Daniel S.; Rumberger, John A.; Blumenthal, Roger S.; Nasir, Khurram

doi:10.1016/j.amjcard.2010.08.019

Cited by 51 publications

(29 citation statements)

References 19 publications

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“…26 Third, participants were relatively old (mean age, 69.5 years), which may limit generalizability of results to younger populations. Moreover, particularly in older individuals calcification of heart valves contributes to cardiovascular mortality, 27,28 and might be important to consider in future studies on vascular calcification and mortality. Fourth, we used the primary cause of death as defined in medical records of general practitioners and hospitals.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Atherosclerotic Calcification in Major Vessel Beds on the Risk of All-Cause and Cause-Specific Mortality

Bos

Leening

Kavousi

et al. 2015

Circ: Cardiovascular Imaging

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Background— Atherosclerosis is a major contributor to global morbidity and mortality. Although atherosclerosis is a systemic disease, its burden varies considerably across vessel beds, which may translate into differences in mortality risk. Methods and Results— From 2003 to 2006, a sample of 2408 elderly participants (mean age, 69.6±6.7 years; 52.4% female) from the population-based Rotterdam Study underwent computed tomography to quantify atherosclerotic calcification in the coronary arteries, aortic arch, extracranial, and intracranial internal carotid arteries. Mortality follow-up was complete until January 1, 2012. We investigated associations of calcification in each vessel bed with mortality using Cox regression, adjusting for age, sex, and cardiovascular risk factors. Next, all vessel beds were included into 1 model to investigate independency of associations. Finally, we investigated the predictive value of calcification beyond the predictors included in the Pooled Cohort equations. During 15 775 person-years of follow-up, 283 participants died. Larger calcification volumes in all vessels were related to higher risks of all-cause mortality, cardiovascular, and noncardiovascular mortality, independent of cardiovascular risk factors. Most prominent associations were found for aortic arch calcification and cardiovascular mortality (age- and sex-adjusted hazard ratio per 1-SD increase 2.72 [95% confidence interval, 1.85–4.02]), independent of calcification elsewhere (hazard ratio, 1.75 (95% confidence interval, 1.13–2.72]). Calcification in any vessel improved prediction for all 3 outcomes. Conclusions— Atherosclerotic load in major vessel beds is associated with an increased risk of death. In particular, aortic arch calcification volume yields unique information with regard to mortality in addition to atherosclerosis in other vessel beds.

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Section: Discussionmentioning

confidence: 99%

Comparison of Atherosclerotic Calcification in Major Vessel Beds on the Risk of All-Cause and Cause-Specific Mortality

Bos

Leening

Kavousi

et al. 2015

Circ: Cardiovascular Imaging

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“…In the general population, screening studies (8) and a meta-analysis of data from smaller series (9) suggest that AVC qualitative assessment may be of prognostic importance. More specifically, in patients with AS, physiological studies advance that because AVC quantification is strongly but nonlinearly (7) associated with hemodynamic measures of AS severity, it may add incremental value to Doppler echocardiography.…”

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confidence: 99%

Impact of Aortic Valve Calcification, as Measured by MDCT, on Survival in Patients With Aortic Stenosis

Clavel

Pîbarot

Messika–Zeitoun

et al. 2014

Journal of the American College of Cardiology

392

203

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BACKGROUND Aortic valve calcification (AVC) load measures lesion severity in aortic stenosis (AS) and is useful for diagnostic purposes. Whether AVC predicts survival after diagnosis, independent of clinical and Doppler echocardiographic AS characteristics, has not been studied. OBJECTIVES This study evaluated the impact of AVC load, absolute and relative to aortic annulus size (AVCdensity), on overall mortality in patients with AS under conservative treatment and without regard to treatment. METHODS In 3 academic centers, we enrolled 794 patients (mean age, 73 ± 12 years; 274 women) diagnosed with AS by Doppler echocardiography who underwent multidetector computed tomography (MDCT) within the same episode of care. Absolute AVC load and AVCdensity (ratio of absolute AVC to cross-sectional area of aortic annulus) were measured, and severe AVC was separately defined in men and women. RESULTS During follow-up, there were 440 aortic valve implantations (AVIs) and 194 deaths (115 under medical treatment). Univariate analysis showed strong association of absolute AVC and AVCdensity with survival (both, p < 0.0001) with a spline curve analysis pattern of threshold and plateau of risk. After adjustment for age, sex, coronary artery disease, diabetes, symptoms, AS severity on hemodynamic assessment, and LV ejection fraction, severe absolute AVC (adjusted hazard ratio [HR]: 1.75; 95% confidence interval [CI]: 1.04 to 2.92; p = 0.03) or severe AVCdensity (adjusted HR: 2.44; 95% CI: 1.37 to 4.37; p = 0.002) independently predicted mortality under medical treatment, with additive model predictive value (all, p ≤ 0.04) and a net reclassification index of 12.5% (p = 0.04). Severe absolute AVC (adjusted HR: 1.71; 95% CI: 1.12 to 2.62; p = 0.01) and severe AVCdensity (adjusted HR: 2.22; 95% CI: 1.40 to 3.52; p = 0.001) also independently predicted overall mortality, even with adjustment for time-dependent AVI. CONCLUSIONS This large-scale, multicenter outcomes study of quantitative Doppler echocardiographic and MDCT assessment of AS shows that measuring AVC load provides incremental prognostic value for survival beyond clinical and Doppler echocardiographic assessment. Severe AVC independently predicts excess mortality after AS diagnosis, which is greatly alleviated by AVI. Thus, measurement of AVC by MDCT should be considered for not only diagnostic but also risk-stratification purposes in patients with AS.

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“…The prevalence of AVC in the elderly population (>75 years old) is approximately 50%, and 25% of those with AVC develop aortic valve stenosis [1]. AVC prevalence and severity are associated with coronary artery disease (CAD) [2], all-cause mortality [3] and aortic stenosis [4]. AVC shares several risk factors with atherosclerosis including age, male gender, dyslipidaemia, smoking, hypertension, diabetes and obesity [5].…”

Section: Introductionmentioning

confidence: 99%

Lipoprotein(a) levels are associated with aortic valve calcification in asymptomatic patients with familial hypercholesterolaemia

Vongpromek¹,

Bos²,

Kate

et al. 2015

J Intern Med

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Objectives. Lipoprotein(a) [Lp(a)] is an independent risk factor for aortic valve stenosis and aortic valve calcification (AVC) in the general population. In this study, we determined the association between AVC and both plasma Lp(a) levels and apolipoprotein(a) [apo(a)] kringle IV repeat polymorphisms in asymptomatic statin-treated patients with heterozygous familial hypercholesterolaemia (FH).Methods. A total of 129 asymptomatic heterozygous FH patients (age 40-69 years) were included in this study. AVC was detected using computed tomography scanning. Lp(a) concentration and apo(a) kringle IV repeat number were measured using immunoturbidimetry and immunoblotting, respectively. Univariate and multivariate logistic regression were used to assess the association between Lp(a) concentration and the presence of AVC.Results. Aortic valve calcification was present in 38.2% of patients, including three with extensive AVC (>400 Agatston units). Lp(a) concentration was significantly correlated with gender, number of apo(a) kringle IV repeats and the presence and severity of AVC, but not with coronary artery calcification (CAC). AVC was significantly associated with plasma Lp(a) level, age, body mass index, blood pressure, duration of statin use, cholesterolyear score and CAC score. After adjustment for all significant covariables, plasma Lp(a) concentration remained a significant predictor of AVC, with an odds ratio per 10-mg dL À1 increase in Lp(a) concentration of 1.11 (95% confidence interval 1.01-1.20, P = 0.03).Conclusion. In asymptomatic statin-treated FH patients, plasma Lp(a) concentration is an independent risk indicator for AVC.

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Relation of Aortic Valve Calcium Detected by Cardiac Computed Tomography to All-Cause Mortality

Cited by 51 publications

References 19 publications

Comparison of Atherosclerotic Calcification in Major Vessel Beds on the Risk of All-Cause and Cause-Specific Mortality

Comparison of Atherosclerotic Calcification in Major Vessel Beds on the Risk of All-Cause and Cause-Specific Mortality

Impact of Aortic Valve Calcification, as Measured by MDCT, on Survival in Patients With Aortic Stenosis

Lipoprotein(a) levels are associated with aortic valve calcification in asymptomatic patients with familial hypercholesterolaemia

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