Prognostic significance of aortic valve calcium in relation to coronary artery calcification for long-term, cause-specific mortality: Results from the CAC Consortium

Donghee Han, Rhanderson Cordoso, Seamus Whelton, Alan Rozanski, Matthew J. Budoff, Michael D. Miedema, Khurram Nasir, Leslee J. Shaw, John A. Rumberger, Heidi Gransar, Zeina Dardari, Roger S. Blumenthal, Michael J. Blaha, Daniel S. Berman

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Aims: Aortic valve calcification (AVC) has been shown to be associated with increased cardiovascular disease (CVD) risk; however, whether this is independent of traditional risk factors and coronary artery calcification (CAC) remains unclear. Methods and results: From the multicentre CAC Consortium database, 10 007 patients (mean 55.8±11.7 years, 64% male) with concomitant CAC and AVC scoring were included in the current analysis. AVC score was quantified using the Agatston score method and categorized as 0, 1-99, and ≥100. The endpoints were all-cause, CVD, and coronary heart disease (CHD) deaths. AVC (AVC>0) was observed in 1397 (14%) patients. During a median 7.8 (interquartile range: 4.7-10.6) years of study follow-up, 511 (5.1%) deaths occurred; 179 (35%) were CVD deaths, and 101 (19.8%) were CHD deaths. A significant interaction between CAC and AVC for mortality was observed (P<0.001). The incidence of mortality events increased with higher AVC; however, AVC ≥100 was not independently associated with all-cause, CVD, and CHD deaths after adjusting for CVD risk factors and CAC (P=0.192, 0.063, and 0.206, respectively). When further stratified by CAC<100 or ≥100, AVC ≥100 was an independent predictor of all-cause and CVD deaths only in patients with CAC <100, after adjusting for CVD risk factors and CAC [hazard ratio (HR): 1.93, 95% confidence interval (CI): 1.14-3.27; P=0.013 and HR: 2.71, 95% CI: 1.15-6.34; P=0.022, respectively]. Conclusion: Although the overall prognostic significance of AVC was attenuated after accounting for CAC, high AVC was independently associated with all-cause and CVD deaths in patients with low coronary atherosclerosis burden.

Original languageEnglish (US)
Pages (from-to)1257-1263
Number of pages7
JournalEuropean Heart Journal Cardiovascular Imaging
Volume22
Issue number11
DOIs
StatePublished - Nov 1 2021

Keywords

  • aortic valve sclerosis
  • cardiovascular mortality
  • computed tomography
  • coronary artery calcium
  • prognosis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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