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Batista R, Benfari G, Essayagh B, Maalouf J, Thapa P, Pellikka PA, Michelena HI, Enriquez-Sarano M. Degenerative mitral stenosis by echocardiography: presentation and outcome. Eur Heart J Cardiovasc Imaging 2024; 26:118-125. [PMID: 39301952 DOI: 10.1093/ehjci/jeae246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 07/02/2024] [Accepted: 09/15/2024] [Indexed: 09/22/2024] Open
Abstract
AIMS Degenerative mitral stenosis (DMS) is due to degenerative mitral annular calcification (MAC) and valvular calcification. However, DMS impacts on the outcome, and therefore, potential treatment needs are poorly known. We aimed at evaluating survival after DMS diagnosis by Doppler echocardiography in routine practice. METHODS AND RESULTS A cohort of 2937 (75 ± 12 years, 67% women) consecutive patients were diagnosed between 2003 and 2014 with DMS (diastolic mean gradient ≥ 5 mmHg), with analysis of short- and long-term survival. All patients had overt mitral annular/valvular degenerative calcification without rheumatic involvement. Mean gradient was 6.5 ± 2.4 mmHg, and DMS was considered mild in 50%, moderate in 44%, and severe in 6%. DMS was associated with left atrial enlargement (52 ± 23 mL/m2) and elevated pulmonary pressure (49 ± 16 mmHg) despite generally normal ejection fraction (61 ± 13%). DMS was associated with frequent comorbid conditions (74% hypertension, 58% coronary disease, and 52% heart failure) and humoural alterations (haemoglobin 11.3 ± 1.8 g/dL and creatinine 1.5 ± 1.4 mg/dL). One-year mortality was 22%, most strongly related to older age, higher comorbidity, and abnormal haemoglobin/creatinine but only weakly to DMS severity (with anaemia 42% irrespective of DMS severity, P = 0.99; without anaemia 18, 23, and 28% with mild, moderate, and severe DMS, respectively, P < 0.0004). Long-term mortality was high (56% at 5 years) also mostly linked to aging and weakly to DMS severity [with anaemia P = 0.90; without anaemia: adjusted-hazard ratio: 1.30 (1.19-1.42), P < 0.0001, for moderate vs. mild DMS and 1.63 (1.34-1.98), P < 0.0001, for severe vs. mild DMS]. CONCLUSION DMS is a condition of the elderly potentially resulting in severe mitral obstruction and haemodynamic alterations. However, DMS is frequently associated with severe comorbidities imparting considerable mortality following diagnosis, whereas DMS severity is a weak (albeit independent) determinant of mortality. Hence, patients with DMS should be carefully evaluated and interventional/surgical treatment prudently considered in those with limited comorbidity burden, particularly without anaemia. Keywords: Degenerative Mitral Stenosis; Outcome; Natural history; Ecocardiography; Mitral Stenosis.
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Affiliation(s)
- Roberta Batista
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
| | - Giovanni Benfari
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
- Section of Cardiology, University of Verona, Verona, Italy
| | - Benjamin Essayagh
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
| | - Joseph Maalouf
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
| | - Prabin Thapa
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
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Cintosun A, Belzile D, Sooriyakanthan M, Orchanian-Cheff A, Tsang W. Thrombus on Mitral Annular Calcification: A Systematic Review of Management and Outcomes. CJC Open 2024; 6:1538-1548. [PMID: 39735945 PMCID: PMC11681350 DOI: 10.1016/j.cjco.2024.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 09/06/2024] [Indexed: 12/31/2024] Open
Abstract
Background Mitral annular calcification (MAC) is a common chronic degenerative process of the mitral valve. Thrombus formation on MAC is a rare complication that likely contributes to the increased risk of thromboembolic events. Outcomes and management strategies for this condition are unknown. The aim of this study was to perform a systematic review to describe the management and outcomes of patients who have thrombus on MAC. Methods The MEDLINE, Embase, and Cochrane databases were searched. Patients with a prior mitral valve intervention or prosthesis were excluded. The primary outcomes were treatment, mortality, and thromboembolic events. Results Fifteen studies, with a total of 22 cases (patients aged 69.1 ± 14.8 years; n = 18 [82%] female) were included. Most patients presented with stroke or a transient ischemic event (n = 15; 68%) or myocardial infarction (n = 4; 18%). All patients were diagnosed with either transthoracic (n = 18; 82%) or transesophageal (n = 4; 18%) echocardiography. Seventeen patients (77%) were treated with anticoagulation therapy alone, and 5 (23%) required surgery. The most common surgical indication was prevention of recurrent embolization (n = 3; 14%). No mortality was reported. Six patients (27%) had thromboembolic events after diagnosis. For those treated with anticoagulation therapy alone, 5 (23%) had persistent thrombus with or without embolization. Conclusions In this systematic review, patients with MAC who present with a thromboembolic event require careful echocardiographic assessment of the MAC, to exclude the presence of thrombus. Although most patients can be managed with anticoagulation therapy alone, a significant number will require surgery. Persistent thrombus, despite anticoagulation therapy, and recurrent embolization are common. Larger studies are needed to elucidate what constitutes the optimal long-term care for these patients.
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Affiliation(s)
- Amber Cintosun
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David Belzile
- Division of Cardiology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Maala Sooriyakanthan
- Division of Cardiology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ani Orchanian-Cheff
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Wendy Tsang
- Division of Cardiology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
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Huish S, Sinha S. New therapeutic perspectives for vascular and valvular calcifications in chronic kidney disease. Curr Opin Nephrol Hypertens 2024; 33:391-397. [PMID: 38573243 DOI: 10.1097/mnh.0000000000000985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
PURPOSE OF REVIEW Vascular and valvular calcification are associated with cardiovascular morbidity and mortality in people with chronic kidney disease (CKD). Uncertainty exists regarding therapeutic strategies to attenuate calcification. This review outlines the pathophysiological mechanisms contributing to vascular and valvular calcification, considers the mechanisms of action of therapeutic interventions, and reports the latest outcomes from interventional studies. RECENT FINDINGS Conventional therapies targeted at CKD-mineral and bone disorder (MBD) modulation have yielded conflicting or inconclusive results. Magnesium and vitamin K supplementation appear to offer attenuation of coronary artery calcification but inconsistent findings justify the need for further studies. Strategies targeting hydroxyapatite formation such as sodium thiosulphate and hexasodium fytate show promise and are worthy of further evaluation. The serum calcification propensity assay (T50) correlates with severity and progression; it holds promise as a potential future clinical tool for screening monitoring calcification risk. SUMMARY Whilst knowledge of the pathophysiology of vascular calcification has grown and therapeutic approaches appear promising, as yet no medication has been approved to treat vascular or valvular calcification, or calciphylaxis.
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Affiliation(s)
- Sharon Huish
- Department of Renal Dietetics, Royal Devon University Healthcare NHS Foundation Trust, and University of Exeter
| | - Smeeta Sinha
- Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust
- Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
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Moradi M, Jahromi AS. Prognostic value of mitral annular calcification in coronary atherosclerotic disease assessed by coronary computed tomographic angiography. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2024; 29:3. [PMID: 38524747 PMCID: PMC10956555 DOI: 10.4103/jrms.jrms_53_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 08/06/2023] [Accepted: 09/21/2023] [Indexed: 03/26/2024]
Abstract
Background There is a lack of evidence on the link between mitral annular calcification (MAC) and coronary atherosclerotic diseases. The present investigation was undertaken to detect the clinical and prognostic value of MAC in coronary atherosclerotic diseases in patients who underwent coronary computed tomographic (CT) angiography. Materials and Methods Two hundred and five individuals with MAC and without it (n = 85 and 120, respectively) were included in the present cross-sectional study. Coronary artery disease-reporting and data system (CAD-RADS) at coronary CT angiography was used to define the severity of coronary atherosclerotic diseases. Patients were classified into no or non-significant CAD (CAD-RADS 0-2) and significant CAD (CAD-RADS 3-5) according to the severity of coronary atherosclerotic diseases. The association of MAC with two mentioned groups (no or non-significant CAD and significant CAD) was assessed using the Chi-squared test and logistic regression in crude and adjusted models. Results Patients with MAC were significantly older (69.34 ± 8.20 vs. 60.64 ± 11.42, P < 0.001), had lower glomerular infiltration rate (69.67 ± 20.92 vs. 78.00 ± 20.23, P = 0.005), and higher coronary artery calcification score (352.87 ± 495.85 vs. 200.55 ± 426.13, P = 0.05) in comparison to those without MAC. However, the significant difference between the two groups regarding coronary artery calcification score disappeared after adjustment for confounders (P = 0.14). In addition, a statistically significant positive link between MAC and significant CAD was observed (odds ratio [OR] [95% confidence interval (CI)]: 1.96 [1.04-3.71], P = 0.04). Nevertheless, the association became statistically insignificant after adjustment for confounders (OR [95% CI]: 1.60 [0.78-3.28], P = 0.2). Conclusion The findings of the study revealed that MAC has no independent prognostic value in coronary atherosclerotic diseases evaluated by coronary CT angiography.
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Affiliation(s)
- Maryam Moradi
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Ye W, Li L, Zeng J. Association of Cardiac Valve Calcification and 1-year Mortality after Lower-extremity Amputation in Diabetic Patients: A Retrospective Study. Curr Neurovasc Res 2024; 20:599-607. [PMID: 38083889 DOI: 10.2174/0115672026277348231130112221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/18/2023] [Accepted: 10/24/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Cardiac valve calcification predisposes patients to a higher risk of adverse cardiovascular events. This study aimed to investigate the association between cardiac valve calcification and 1-year mortality in diabetic patients after lower-extremity amputation. METHODS This was a retrospective study conducted on the clinical data of diabetic patients who underwent lower-extremity amputation admitted to the Sun Yat-sen Memorial Hospital, Guangzhou, Guangdong, China for diabetic foot ulcers needed lower extremity amputation surgery between July 2017 and March 2021. Detailed preoperative medical assessments were performed and recorded. Cardiac valve calcification was assessed using echocardiography at baseline. Oneyear follow-up assessments were conducted and included clinical visits, hospital record assessments, and telephone reviews to obtain the survival status of patients. RESULTS Ninety-three diabetic patients participated in the study. The 1-year follow-up mortality rate after amputation was 24.7%. Compared to the survival group, the prevalence of cardiac valve calcification and the Revised Cardiac Risk Index (RCRI) were higher in the mortality group. In the Cox regression analysis, cardiac valvular calcification (HR=3.427, 95% CI=1.125- 10.443, p =0.030) was found to be an independent predictor of all-cause mortality after amputation. In addition, the patients with both aortic valve calcification and mitral annular calcification had a higher all-cause mortality rate (50%). Receiver operator characteristic curve analysis showed a stronger predictive ability when using a combination of calcified valve number and RCRI (AUC=0.786 95%, CI=0.676-0.896, p =0.000). CONCLUSION In diabetic patients after lower-extremity amputation, cardiac valve calcification was associated with all-cause mortality during 1-year follow-up. Combination of calcified valve number and RCRI score showed a stronger predictive value for mortality.
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Affiliation(s)
- Weibin Ye
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510000, China
| | - Li Li
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510000, China
| | - Jianfeng Zeng
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510000, China
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Churchill TW, Yucel E, Bernard S, Namasivayam M, Nagata Y, Lau ES, Deferm S, He W, Danik JS, Sanborn DY, Picard MH, Levine RA, Hung J, Bertrand PB. Sex Differences in Extensive Mitral Annular Calcification With Associated Mitral Valve Dysfunction. Am J Cardiol 2023; 193:83-90. [PMID: 36881941 PMCID: PMC10066827 DOI: 10.1016/j.amjcard.2023.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 03/07/2023]
Abstract
Mitral annular calcification (MAC)-related mitral valve (MV) dysfunction is an increasingly recognized entity, which confers a high burden of morbidity and mortality. Although more common among women, there is a paucity of data regarding how the phenotype of MAC and the associated adverse clinical implications may differ between women and men. A total of 3,524 patients with extensive MAC and significant MAC-related MV dysfunction (i.e., transmitral gradient ≥3 mm Hg) were retrospectively analyzed from a large institutional database, with the goal of defining gender differences in clinical and echocardiographic characteristics and the prognostic importance of MAC-related MV dysfunction. We stratified patients into low- (3 to 5 mm Hg), moderate- (5 to 10 mm Hg), and high- (≥10 mm Hg) gradient groups and analyzed the gender differences in phenotype and outcome. The primary outcome was all-cause mortality, assessed using adjusted Cox regression models. Women represented the majority (67%) of subjects, were older (79.3 ± 10.4 vs 75.5 ± 10.9 years, p <0.001) and had a lower burden of cardiovascular co-morbidities than men. Women had higher transmitral gradients (5.7 ± 2.7 vs 5.3 ± 2.6 mm Hg, p <0.001), more concentric hypertrophy (49% vs 33%), and more mitral regurgitation. The median survival was 3.4 years (95% confidence interval 3.0 to 3.6) among women and 3.0 years (95% confidence interval 2.6 to 4.5) among men. The adjusted survival was worse among men, and the prognostic impact of the transmitral gradient did not differ overall by gender. In conclusion, we describe important gender differences among patients with MAC-related MV dysfunction and show worse adjusted survival among men; although, the adverse prognostic impact of the transmitral gradient was similar between men and women.
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Affiliation(s)
- Timothy W Churchill
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Evin Yucel
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Samuel Bernard
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Cardiology, New York University School of Medicine, New York University, New York, New York
| | - Mayooran Namasivayam
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Victor Chang Cardiac Research Institute, St. Vincent's Hospital, University of New South Wales, Sydney, Australia
| | - Yasufumi Nagata
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; The Second Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Emily S Lau
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sebastien Deferm
- Department of Cardiology, Mainz University Hospital, Mainz Germany
| | - Wei He
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jacqueline S Danik
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Danita Y Sanborn
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael H Picard
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert A Levine
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Judy Hung
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Philippe B Bertrand
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Ziekenhuis Oost-Limburg, Genk, Belgium
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Calcific mitral valve disease: The next challenging disease. Arch Cardiovasc Dis 2022; 115:613-616. [PMID: 36347773 DOI: 10.1016/j.acvd.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 09/20/2022] [Indexed: 12/15/2022]
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Khurana R, Yadav A, Buxi TBS, Rawat KS, Ghuman SS. Non-traditional tools for predicting coronary artery disease. THE NATIONAL MEDICAL JOURNAL OF INDIA 2022; 35:261-265. [PMID: 37167490 DOI: 10.25259/nmji_513_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Background The traditional coronary calcium score (CCS) is a time-tested tool for the evaluation of coronary atherosclerosis and predictor of future cardiovascular events. Non-traditional tools can also have a value in predicting and detecting subclinical coronary artery disease (CAD). Methods We studied the role of CCS, the traditional CAD risk predictor, and the less-recognized, non-traditional risk factors, i.e. epicardial fat volume (EFV) and thoracic extracoronary calcium (ECC), to assess the degree of subclinical CAD. In this cross-sectional observational study, we included 950 Indian patients (suspected to have CAD). Coronary computed tomography angiography was performed. Estimation of CCS, EFV and thoracic ECC was done. Results A CCS of 0 was seen in 583 patients (61.4%). Of these, 492 patients had normal coronary angiogram but 91 patients had CAD. The median values of EFV were statistically significantly higher in the 'CAD present and CCS 0' group compared to the 'CAD absent and CCS 0' group (p<0.001). The presence of thoracic ECC involving at least a single site was seen in only 6 of these 91 patients. When both EFV and CCS were considered together for the detection of CAD, the sensitivity and negative predictive value (NPV) were improved compared to either of these in isolation. When ECC was taken together with CCS and EFV, no further improvement in sensitivity or NPV was observed. Conclusion The combined use of traditional CCS along with non-traditional EFV may guide us in better profiling cardiovascular risk and supplement the various traditional cardiovascular risk factors/scores.
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Affiliation(s)
- Rishabh Khurana
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Anurag Yadav
- Department of CT and MRI, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi 110060, India
| | - T B S Buxi
- Department of CT and MRI, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi 110060, India
| | - Kishan Singh Rawat
- Department of CT and MRI, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi 110060, India
| | - Samarjit S Ghuman
- Department of CT and MRI, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi 110060, India
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Willner N, Burwash IG, Beauchesne L, Chan V, Vulesevic B, Ascah K, Coutinho T, Promislow S, Stadnick E, Chan KL, Mesana T, Messika-Zeitoun D. Natural History of Mitral Annulus Calcification and Calcific Mitral Valve Disease. J Am Soc Echocardiogr 2022; 35:925-932. [PMID: 35618253 DOI: 10.1016/j.echo.2022.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 03/05/2022] [Accepted: 05/10/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The natural history of mitral annular calcification (MAC) and risk for developing calcific mitral valve disease (CMVD) has been poorly defined. We sought to evaluate the progression rate of MAC and of the development of CMVD. METHODS Patients with MAC and paired echocardiograms at least one year apart between 2005 and 2019 were included. Progression rates from mild/moderate to severe MAC and to CMVD (defined as severe MAC and significant mitral stenosis and/or regurgitation) were assessed, along with potential association with sex. RESULTS A total of 11,605 patients (73±10years, 51%male) with MAC (78% mild, 17% moderate, 5% severe) were included and had a follow up echocardiogram at 4.2±2.7years. In patients with mild/moderate MAC, 33% presented with severe MAC at 10 years. The rate of severe MAC was higher in females than in males (41% vs. 24%, P<0.001, HR=1.3, P<0.001) and in patients with moderate vs. mild MAC (71% vs. 22%, P<0.001, HR=6.1, P<0.001). At 10 years 10% presented with CMVD (4%, 23% and 60% in patients with mild, moderate, and severe MAC respectively) and was predicted by female sex (15% vs. 5%, P<0.0001), even after adjustment for MAC severity (HR=1.9, P<0.001). CONCLUSION In this large cohort of patients with MAC, progression to severe MAC was common and frequently results in CMVD. Female sex was associated with higher progression rates. MAC and CMVD are expected to dramatically increase as the population ages highlighting the importance of a better understanding of the pathophysiology of MAC in order to develop effective preventive medical therapies.
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Affiliation(s)
- Nadav Willner
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Ian G Burwash
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Luc Beauchesne
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Vince Chan
- Department of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Canada
| | - Branka Vulesevic
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Kathy Ascah
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Thias Coutinho
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Steve Promislow
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Ellamae Stadnick
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Kwan L Chan
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Thierry Mesana
- Department of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Canada
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Jurgens PT, Carr JJ, Terry JG, Rana JS, Jacobs DR, Duprez DA. Association of Abdominal Aorta Calcium and Coronary Artery Calcium with Incident Cardiovascular and Coronary Heart Disease Events in Black and White Middle-Aged People: The Coronary Artery Risk Development in Young Adults Study. J Am Heart Assoc 2021; 10:e023037. [PMID: 34873926 PMCID: PMC9075251 DOI: 10.1161/jaha.121.023037] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 11/04/2021] [Indexed: 11/25/2022]
Abstract
Background Assessing coronary artery calcium (CAC) is among AHA/ACC prevention guidelines for people at least 40 years old at intermediate risk for coronary heart disease (CHD). To study enhanced risk stratification, we investigated the predictive value of abdominal aorta calcium (AAC) relative to CAC for cardiovascular disease (CVD) and CHD events in Black and White early middle-aged participants, initially free of overt CVD. Methods and Results In the CARDIA (Coronary Artery Risk Development in Young Adults) study, a multi-center, community-based, longitudinal cohort study of CVD risk, the CAC and AAC scores were assessed in 3011 participants in 2010-2011 with follow-up until 2019 for incident CVD and CHD events. Distributions and predictions, overall and by race, were computed. During the 8-year follow-up, 106 incident CVD events (55 were CHD) occurred. AAC scores tended to be much higher than CAC scores. AAC scores were higher in Black women than in White women. CAC predicted CVD with HR 1.77 (1.52-2.06) and similarly for AAC, while only CAC predicted CHD. After adjustment for risk factors and calcium in the other arterial bed, the association of CAC with CVD was independent of risk factors and AAC, while the association of AAC with CVD was greatly attenuated. However, AAC predicted incident CVD when CAC was 0. Prediction did not vary by race. Conclusions AAC predicted CVD nearly as strongly as CAC and could be especially useful as a diagnostic tool when it is an incidental finding or when no CAC is found.
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Affiliation(s)
- Paul T. Jurgens
- Division of CardiologyDepartment of MedicineUniversity of MinnesotaMinneapolisMN
| | - John J. Carr
- Division of Radiology and Radiological SciencesVanderbilt University Medical CenterNashvilleTN
| | - James G. Terry
- Division of Radiology and Radiological SciencesVanderbilt University Medical CenterNashvilleTN
| | - Jamal S. Rana
- Division of Cardiology and ResearchKaiser Permanente Northern CaliforniaOaklandCA
| | - David R. Jacobs
- Division of Epidemiology and Community HealthSchool of Public HealthUniversity of MinnesotaMinneapolisMN
| | - Daniel A. Duprez
- Division of CardiologyDepartment of MedicineUniversity of MinnesotaMinneapolisMN
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Coffey S, Roberts-Thomson R, Brown A, Carapetis J, Chen M, Enriquez-Sarano M, Zühlke L, Prendergast BD. Global epidemiology of valvular heart disease. Nat Rev Cardiol 2021; 18:853-864. [PMID: 34172950 DOI: 10.1038/s41569-021-00570-z] [Citation(s) in RCA: 321] [Impact Index Per Article: 80.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 02/05/2023]
Abstract
Valvular heart disease (VHD) is a major contributor to loss of physical function, quality of life and longevity. The epidemiology of VHD varies substantially around the world, with a predominance of functional and degenerative disease in high-income countries, and a predominance of rheumatic heart disease in low-income and middle-income countries. Reflecting this distribution, rheumatic heart disease remains by far the most common manifestation of VHD worldwide and affects approximately 41 million people. By contrast, the prevalence of calcific aortic stenosis and degenerative mitral valve disease is 9 and 24 million people, respectively. Despite a reduction in global mortality related to rheumatic heart disease since 1900, the death rate has remained fairly static since 2000. Meanwhile, deaths from calcific aortic stenosis have continued to rise in the past 20 years. Epidemiological data on other important acquired and congenital forms of VHD are limited. An ageing population and advances in therapies make an examination of the changing global epidemiology of VHD crucial for advances in clinical practice and formulation of health policy. In this Review, we discuss the global burden of VHD, geographical variation in the presentation and clinical management, and temporal trends in disease burden.
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Affiliation(s)
- Sean Coffey
- Department of Medicine - HeartOtago, University of Otago, Dunedin, New Zealand
| | - Ross Roberts-Thomson
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
- Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
| | - Alex Brown
- Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
| | - Jonathan Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia and Perth Children's Hospital, Perth, WA, Australia
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | | | - Liesl Zühlke
- Division of Paediatric Cardiology, Department of Paediatrics, Red Cross War Memorial Children's Hospital, Faculty of Health Sciences University of Cape Town, Cape Town, South Africa
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences University of Cape Town, Cape Town, South Africa
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Karan A, Feghaly J, Guo HJ, Akinjogbin TO, Sattiraju S. A Case of Multiple Calcific Embolic Strokes in a Patient With a Porcelain Left Atrium. Cureus 2021; 13:e18585. [PMID: 34765352 PMCID: PMC8575342 DOI: 10.7759/cureus.18585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 10/07/2021] [Indexed: 11/21/2022] Open
Abstract
Mitral annular calcification (MAC) commonly manifests as an incidental, asymptomatic finding that is associated with several cardiovascular risk factors, atherosclerosis, cardiovascular death, and all-cause mortality. Very rarely, patients with severe MAC can have extensive dystrophic calcification extending into the left atrial wall, termed porcelain left atrium. In this case report, we describe a patient who experienced multiple calcific acute embolic strokes in the setting of severe mitral annular calcification and porcelain left atrium. Our patient presented with multiple, small bilateral acute infarcts scattered throughout the cerebrum and cerebellum confirmed on magnetic resonance imaging (MRI). He was placed on continuous telemetry and underwent multimodal imaging with transthoracic and transesophageal echocardiography, carotid neck ultrasound (US), head and neck computed tomography angiogram (CTA), and cardiac MRI. There were no arrhythmic events detected on telemetry, and all imaging excluded left ventricular thrombi, aortic atheroma, carotid artery stenosis, intracardiac shunting, or large vessel stenosis. Noted on imaging, however, was severe mitral annular calcification with numerous, highly mobile calcific extensions and densely calcified plaque along the posterior left atrial wall, presumed to be the source of this patient's embolic stroke. Cardiac catheterization was significant for severe three-vessel disease requiring coronary artery bypass grafting, and our patient was subsequently discharged to outpatient follow-up on event monitoring and aspirin monotherapy. This case serves to highlight a previously unreported complication of calcific embolic stroke in severe MAC and porcelain left atrium, and highlight the need for further randomized controlled trials to determine the optimum management of these cases.
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Affiliation(s)
- Abhinav Karan
- Internal Medicine, University of Florida College of Medicine, Jacksonville, USA
| | - Julien Feghaly
- Cardiology, University of Florida College of Medicine, Jacksonville, USA
| | - Hui Jun Guo
- Internal Medicine, University of Florida College of Medicine, Jacksonville, USA
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Haensig M, Kuntze T, Gonzalez DL, Lapp H, Lauten P, Owais T. Extensive calcification of the mitral valve annulus in transcatheter aortic valve implants. Interact Cardiovasc Thorac Surg 2021; 34:167-175. [PMID: 34601608 PMCID: PMC8766209 DOI: 10.1093/icvts/ivab235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/13/2021] [Accepted: 07/02/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES This study sought to report the calcification pattern of the mitral valve annulus and its implications for procedural and safety outcomes in transcatheter aortic valve implantation. METHODS Between November 2018 and September 2019, a total of 305 patients had transcatheter aortic valve implants at our institution. The extent of calcification of the mitral valve annulus was analysed, and the impact on safety outcomes was evaluated. RESULTS The prevalence of mitral annular calcification (MAC) was 43%. Calcification of the mitral valve annulus was either less than or at least one-third of the posterior annulus (34% and 32%), the whole posterior annulus (28%) or the extension to the attachment of the anterior leaflets (7%). Severe circumferential MAC revealed moderate paravalvular leaks in 5/8 (63%) patients and was associated with right branch bundle block [odds ratio (OR) 2.01 (0.39–3.06); P = 0.098] and low cardiac output [OR 3.12 (1.39–7.04); P = 0.033]. Subannular calcification at the anterolateral trigonum represented a risk factor for left ventricular outflow tract injury [OR 3.54 (1.38–8.27); P = 0.001] in balloon-expandable valves, associated with relevant rhythm disorders [OR 2.26 (1.17–5.65); P = 0.014] and female gender (7/8, 88%). The 30-day all-cause mortality in circumferential MAC reaching into the anterior annulus (grade IV) compared to patients with less MAC (grade I–III) was 13% vs 2% with a mean valve size of 24.6 vs 25.7 mm. CONCLUSIONS Extensive MAC was associated with moderate paravalvular leaks, with implications for the prosthesis size and survival in transcatheter aortic valve implants. In severe MAC, we recommend implanting oversized self-expandable prostheses, the goal being to reduce the risk of right branch bundle block and paravalvular leaks. Subj collection 122, 125
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Affiliation(s)
- Martin Haensig
- Corresponding author. Department of Cardiothoracic Surgery, Central Clinic Hospital of Bad Berka, Rhön AG, Robert-Koch Allee 9, 99438 Bad Berka, Germany. Tel: +49-364585-41137; fax: +49-364585-3510; e-mail: (M. Haensig)
| | - Thomas Kuntze
- Department of Cardiothoracic Surgery, Central Clinic Hospital of Bad Berka, Bad Berka, Germany
| | - David Lopez Gonzalez
- Department of Cardiothoracic Surgery, Central Clinic Hospital of Bad Berka, Bad Berka, Germany
| | - Harald Lapp
- Department of Cardiology and Internal Medicine, Central Clinic Hospital of Bad Berka, Bad Berka, Germany
| | - Philipp Lauten
- Department of Cardiology and Internal Medicine, Central Clinic Hospital of Bad Berka, Bad Berka, Germany
| | - Tamer Owais
- Department of Cardiothoracic Surgery, Central Clinic Hospital of Bad Berka, Bad Berka, Germany
- Department of Cardiothoracic Surgery, Cairo University, Cairo, Egypt
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Birudaraju D, Cherukuri L, Pranesh S, Budoff MJ. Current methods to assess mitral annular calcification and its risk factors. Expert Rev Cardiovasc Ther 2021; 19:787-800. [PMID: 34348555 DOI: 10.1080/14779072.2021.1964361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Mitral annulus calcification (MAC) is a chronic, non-inflammatory, degenerative mechanism of the fibrous base of the mitral valve. While MAC was originally thought to be an age-related degenerative process, there is evidence that other mechanisms, such as atherosclerosis and abnormal calcium phosphorus metabolism, also contribute to the development of MAC. AREAS COVERED This paper summarizes, existing perception of clinically valid definition of MAC and the pathophysiological processes that lead to the development of MAC and the diagnostic implications of this disease entity. EXPERT OPINION Minimal evidence exists on the natural history and progression of MAC. Characterization of MAC progression and identification of predisposing risk factors can help to validate hypotheses. MAC is most commonly asymptomatic and incidental finding. Echocardiography is the primary imaging modality for identification and characterization of MAC and associated mitral valve (MV) disease. For patients with an indication for MV surgery, computed tomography (CT) is a complementary imaging modality for MAC. MAC is generally recognized by its characteristic density, location, and shape on echocardiography and CT, unusual variants are sometimes confused with other lesions.
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Affiliation(s)
- Divya Birudaraju
- Division Of Cardiology, Lundquist Institute For Biomedical Innovation At Harbor-UCLA, Torrance, California, USA
| | - Lavanya Cherukuri
- Division Of Cardiology, Lundquist Institute For Biomedical Innovation At Harbor-UCLA, Torrance, California, USA
| | - Shruthi Pranesh
- Division Of Cardiology, Penn State Holy Spirit Hospital, Harrisburg, Pennsylvania, USA
| | - Matthew J Budoff
- Division Of Cardiology, Lundquist Institute For Biomedical Innovation At Harbor-UCLA, Torrance, California, USA
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15
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Myasoedova VA, Genovese S, Cavallotti L, Bonomi A, Chiesa M, Campodonico J, Rondinelli M, Cosentino N, Baldassarre D, Veglia F, Pepi M, Alamanni F, Colombo GI, Marenzi G, Poggio P. Aortic Valve Sclerosis in High-Risk Coronary Artery Disease Patients. Front Cardiovasc Med 2021; 8:711899. [PMID: 34386534 PMCID: PMC8354333 DOI: 10.3389/fcvm.2021.711899] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/06/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Current knowledge regarding the relationship between aortic valve sclerosis (AVSc), cardiovascular risk factors, and mortality in patients with known coronary artery disease (CAD) is still unclear. The present study aimed at investigating the prevalence of AVSc as well as its association with long-term all-cause mortality in high-risk CAD patients that has never been explored in large cohorts thus far. Methods and Results: In this retrospective and observational cohort study we enrolled high-risk CAD patients, hospitalized at Centro Cardiologico Monzino (CCM), Milan, Italy, between January 2006 and December 2016. The morphology and function of the aortic valve were assessed from the recorded echocardiographic images to evaluate the presence of AVSc, defined as a non-uniform thickening of the aortic leaflets with no consequences on hemodynamics. Data on 5-year all-cause mortality was retrieved from a Regional database. Of the 5,489 patients initially screened, 4,938 (mean age 67 ± 11 years, 3,954 [80%] men) were enrolled in the study. In the overall population, AVSc was detected in 2,138 (43%) patients. Multivariable LASSO regression revealed that age, female gender, diabetes mellitus, previous MI, and left ventricular ejection fraction were independently associated with AVSc. All-cause mortality (adjusted hazard ratio: 1.29, 95%CI: 1.05–1.58) was significantly higher in AVSc than in non-AVSc patients. Conclusions: AVSc is frequently detected in high-risk CAD patients and is associated with long-term mortality. Our findings corroborate the hypothesis that AVSc is an underestimated marker of systemic cardiovascular risk. Thus, AVSc detection may be used to improve long-term risk stratification of high-risk CAD patients.
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Affiliation(s)
- Veronika A Myasoedova
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Stefano Genovese
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Laura Cavallotti
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Alice Bonomi
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Mattia Chiesa
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Jeness Campodonico
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Maurizio Rondinelli
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Nicola Cosentino
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Damiano Baldassarre
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Fabrizio Veglia
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Francesco Alamanni
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Gualtiero I Colombo
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Giancarlo Marenzi
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Paolo Poggio
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
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Garg PK, Buzkova P, Meyghani Z, Budoff MJ, Lima J, Criqui M, Cushman M, Allison M. Valvular calcification and risk of peripheral artery disease: the Multi-Ethnic Study of Atherosclerosis (MESA). Eur Heart J Cardiovasc Imaging 2021; 21:1152-1159. [PMID: 31740939 DOI: 10.1093/ehjci/jez284] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/20/2019] [Accepted: 10/25/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS The detection of cardiac valvular calcification on routine imaging may provide an opportunity to identify individuals at increased risk for peripheral artery disease (PAD). We investigated the associations of aortic valvular calcification (AVC) and mitral annular calcification (MAC) with risk of developing clinical PAD or a low ankle-brachial index (ABI). METHODS AND RESULTS AVC and MAC were measured on cardiac computed tomography in 6778 Multi-Ethnic Study of Atherosclerosis participants without baseline PAD between 2000 and 2002. Clinical PAD was ascertained through 2015. Incident low ABI, defined as ABI <0.9 and decline of ≥0.15, was assessed among 5762 individuals who had an ABI >0.9 at baseline and at least one follow-up ABI measurement 3-10 years later. Adjusted Cox proportional hazards and Poisson regression modelling were used to determine the association of valvular calcification with clinical PAD and low ABI, respectively. There were 117 clinical PAD and 198 low ABI events that occurred over a median follow-up of 14 years and 9.2 years, respectively. The presence of MAC was associated with an increased risk of clinical PAD [hazard ratio 1.79; 95% confidence interval (CI) 1.04-3.05] but not a low ABI (rate ratio 1.28; 95% CI 0.75-2.19). No significant associations were noted for the presence of AVC and risk of either clinical PAD. CONCLUSION MAC is associated with an increased risk of developing clinical PAD. Future studies are needed to corroborate our findings and better understand whether MAC holds any predictive value as a risk marker for PAD.
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Affiliation(s)
- Parveen K Garg
- Division of Cardiology, University of Southern California Keck School of Medicine, 1510 San Pablo St. Suite 322, Los Angeles, CA, USA
| | - Petra Buzkova
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Zahra Meyghani
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Joao Lima
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Criqui
- Division of Preventive Medicine, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - Mary Cushman
- Department of Medicine and Pathology & Laboratory Medicine, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Matthew Allison
- Division of Preventive Medicine, University of California, San Diego School of Medicine, San Diego, CA, USA
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17
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Martínez Fernández L, Sánchez-Alvarez JE, Morís de la Tassa C, Bande Fernández JJ, María V, Fernández E, Valdivielso JM, Betriu A. Risk factors associated with valvular calcification in patients with chronic kidney disease. Analysis of NEFRONA study. Nefrologia 2021; 41:337-346. [PMID: 36166249 DOI: 10.1016/j.nefroe.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 08/14/2020] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION Patients with chronic kidney disease (CKD) are at high risk of cardiovascular morbidity and mortality. Subclinical cardiac structural alterations have prognostic value in these patients. The aim was to analyse the prevalence of valvular calcification, the evolution and the relationship with different risk factors. MATERIAL AND METHODS Part of the sample of the NEFRONA study was randomly selected. Aortic and mitral valve calcification were analysed in echocardiograms performed at the baseline visit and at 24 months. RESULTS We included 397 patients, the estimated basal glomerular filtrate (eGFR) was 33 ml/min with significant decrease to 30.9 ml/min. There was an increase in the area of carotid and femoral plaque, as well as an increase in patients with aortic and mitral calcification at 24 months. A positive association of mitral calcification at 24 months with age, ankle-brachial index (ABI) and calcium-phosphorus product (CaxP) at baseline visit was observed, without association with eGFR. Aortic calcification at 24 months was positively associated with age, phosphorous and total carotid plaque area at baseline, with no relationship to eGFR. CONCLUSIONS A significant prevalence of valvular calcification was observed in patients with CKD without known cardiovascular disease.Two-year progression was observed independently of the eGFR. Patients with higher risk of mitral valve calcification were those with older age, higher ABI and CaxP product. Patients with a higher risk of aortic calcification were those with older age, higher phosphorous levels and larger area of carotid plaque. Identifying these higher risk patients would help to avoid future cardiovascular events intensifying follow-ups.
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Affiliation(s)
| | - J Emilio Sánchez-Alvarez
- Hospital Universitario de Cabueñes, Gijón, Asturias, Spain; Red de Investigación Renal (REDINREN), Spain
| | | | | | - Virtudes María
- Vascular and Renal Translational, Research Group, Institut de Recerca Biomèdica, Lleida, Spain
| | - Elvira Fernández
- Vascular and Renal Translational, Research Group, Institut de Recerca Biomèdica, Lleida, Spain
| | - Jose M Valdivielso
- Vascular and Renal Translational, Research Group, Institut de Recerca Biomèdica, Lleida, Spain
| | - Angels Betriu
- Vascular and Renal Translational, Research Group, Institut de Recerca Biomèdica, Lleida, Spain
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18
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Hardas S, Titar P, Zanwar I, Phalgune DS. Correlation between echocardiographic calcium score and coronary artery lesion severity on invasive coronary angiography. Indian Heart J 2021; 73:307-312. [PMID: 34154747 PMCID: PMC8322811 DOI: 10.1016/j.ihj.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/13/2021] [Accepted: 03/23/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES The direct correlation between Echocardiographic non-coronary calcium score (ECS) and lesion severity on invasive coronary angiography (ICA) is not reported. The aim of the present study was to find the correlation between ECS and Gensini score. METHODS One hundred seventy patients aged ≥18 years posted for clinically indicated ICA were included. All the patients underwent standard transthoracic echocardiography. ECS and Gensisni scores were calculated. The primary outcome measure was to find a correlation of ECS with Gensini score, whereas the secondary outcome measure was to correlate ECS with traditional risk factors for coronary artery disease. The Chi-square/Fisher exact test was used to compare qualitative variables. Spearman's correlation analysis was used for assessing the correlation between ECS score and the Gensini score. Receiver-operating characteristic curve analysis was performed to detect the cut-off value of the ECS score. RESULTS The correlation of total ECS with Gensini score was positive and statistically significant (r = 0.550, p-value < 0.0001). As ECS increased, the Gensini score increased. ECS value of >1 detected CAD with 56.5% sensitivity, 79.5% specificity. Eight-nine percent of patients who had ECS >1, had Gensini score ≥18, whereas 44.3% of patients who had ECS ≤1, had Gensini score ≥18. The patients with ECS >1 had significantly higher Gensini scores than the patients with ECS ≤1. CONCLUSIONS The correlation of total ECS with Gensini score was positive and statistically significant.
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Affiliation(s)
- Suhas Hardas
- Dept. of Cardiology, Poona Hospital & Research Centre, Pune, India.
| | - Pritam Titar
- Dept. of Cardiology, Poona Hospital & Research Centre, Pune, India.
| | - Ishwar Zanwar
- Dept. of Cardiology, Poona Hospital & Research Centre, Pune, India.
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19
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Tanaka DK, Yanagawa B. Mitral annular calcification: Bad versus worse. J Card Surg 2021; 36:2419-2420. [PMID: 33797805 DOI: 10.1111/jocs.15529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Dustin K Tanaka
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Bobby Yanagawa
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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20
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Williams MC, Massera D, Moss AJ, Bing R, Bularga A, Adamson PD, Hunter A, Alam S, Shah ASV, Pawade T, Roditi G, van Beek EJR, Nicol ED, Newby DE, Dweck MR. Prevalence and clinical implications of valvular calcification on coronary computed tomography angiography. Eur Heart J Cardiovasc Imaging 2021; 22:262-270. [PMID: 33306104 PMCID: PMC7899264 DOI: 10.1093/ehjci/jeaa263] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/07/2020] [Indexed: 12/11/2022] Open
Abstract
AIMS Valvular heart disease can be identified by calcification on coronary computed tomography angiography (CCTA) and has been associated with adverse clinical outcomes. We assessed aortic and mitral valve calcification in patients presenting with stable chest pain and their association with cardiovascular risk factors, coronary artery disease, and cardiovascular outcomes. METHODS AND RESULTS In 1769 patients (58 ± 9 years, 56% male) undergoing CCTA for stable chest pain, aortic and mitral valve calcification were quantified using Agatston score. Aortic valve calcification was present in 241 (14%) and mitral calcification in 64 (4%). Independent predictors of aortic valve calcification were age, male sex, hypertension, diabetes mellitus, and cerebrovascular disease, whereas the only predictor of mitral valve calcification was age. Patients with aortic and mitral valve calcification had higher coronary artery calcium scores and more obstructive coronary artery disease. The composite endpoint of cardiovascular mortality, non-fatal myocardial infarction, or non-fatal stroke was higher in those with aortic [hazard ratio (HR) 2.87; 95% confidence interval (CI) 1.60-5.17; P < 0.001] or mitral (HR 3.50; 95% CI 1.47-8.07; P = 0.004) valve calcification, but this was not independent of coronary artery calcification or obstructive coronary artery disease. CONCLUSION Aortic and mitral valve calcification occurs in one in six patients with stable chest pain undergoing CCTA and is associated with concomitant coronary atherosclerosis. Whilst valvular calcification is associated with a higher risk of cardiovascular events, this was not independent of the burden of coronary artery disease.
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Affiliation(s)
- Michelle C Williams
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh EH164TJ, UK
| | - Daniele Massera
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Alastair J Moss
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
| | - Rong Bing
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
| | - Anda Bularga
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
| | - Philip D Adamson
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
- Christchurch Heart Institute, University of Otago, Christchurch 8140, New Zealand
| | - Amanda Hunter
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
| | - Shirjel Alam
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
| | - Anoop S V Shah
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
| | - Tania Pawade
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
| | - Giles Roditi
- Glasgow Clinical Research Imaging Facility, Queen Elizabeth University Hospital, Glasgow G514LB, UK
| | - Edwin J R van Beek
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh EH164TJ, UK
| | | | - David E Newby
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh EH164TJ, UK
| | - Marc R Dweck
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh EH164TJ, UK
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Martínez Fernández L, Sánchez-Alvarez JE, Morís de la Tassa C, Bande Fernández JJ, María V, Fernández E, Valdivielso JM, Betriu A. [Risk factors associated with valvular calcification in patients with chronic kidney disease. Analysis of NEFRONA Study]. Nefrologia 2020; 41:337-346. [PMID: 33358625 DOI: 10.1016/j.nefro.2020.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 08/04/2020] [Accepted: 08/14/2020] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Patients with chronic kidney disease (CKD) are at high risk of cardiovascular morbidity and mortality. Subclinical cardiac structural alterations have prognostic value in these patients. The aim was to analyse the prevalence of valvular calcification, the evolution and the relationship with different risk factors. MATERIAL AND METHODS Part of the sample of the NEFRONA study was randomly selected. Aortic and mitral valve calcification were analysed in echocardiograms performed at the baseline visit and at 24 months. RESULTS We included 397 patients, the estimated basal glomerular filtrate (eGFR) was 33ml/min with significant decrease to 30.9ml/min. There was an increase in the area of carotid and femoral plaque, as well as an increase in patients with aortic and mitral calcification at 24 months. A positive association of mitral calcification at 24 months with age, ankle-brachial index (ABI) and calcium-phosphorus product (CaxP) at baseline visit was observed, without association with eGFR. Aortic calcification at 24 months was positively associated with age, phosphorous and total carotid plaque area at baseline, with no relationship to eGFR. CONCLUSIONS A significant prevalence of valvular calcification was observed in patients with CKD without known cardiovascular disease.Two-year progression was observed independently of the eGFR. Patients with higher risk of mitral valve calcification were those with older age, higher ABI and CaxP product. Patients with a higher risk of aortic calcification were those with older age, higher phosphorous levels and larger area of carotid plaque. Identifying these higher risk patients would help to avoid future cardiovascular events intensifying follow-ups.
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Affiliation(s)
| | - J Emilio Sánchez-Alvarez
- Hospital Universitario de Cabueñes, Gijón, Asturias, España; Red de Investigación Renal (REDINREN), España
| | | | | | - Virtudes María
- Vascular and Renal Translational, Research Group, Institut de Recerca Biomèdica, Lleida, España
| | - Elvira Fernández
- Vascular and Renal Translational, Research Group, Institut de Recerca Biomèdica, Lleida, España
| | - José M Valdivielso
- Vascular and Renal Translational, Research Group, Institut de Recerca Biomèdica, Lleida, España
| | - Angels Betriu
- Vascular and Renal Translational, Research Group, Institut de Recerca Biomèdica, Lleida, España
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Nemchyna O, Soltani S, Solowjowa N, Schoenrath F, Hrytsyna Y, Unbehaun A, Kempfert J, Stein J, Knosalla C, Hagendorff A, Knebel F, Falk V, Knierim J. Validity of visual assessment of aortic valve morphology in patients with aortic stenosis using two-dimensional echocardiography. Int J Cardiovasc Imaging 2020; 37:813-823. [PMID: 33040296 PMCID: PMC7969560 DOI: 10.1007/s10554-020-02048-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/26/2020] [Indexed: 11/30/2022]
Abstract
The diagnostic value of a visual assessment of aortic valve (AV) morphology for grading aortic stenosis (AS) remains unclear. A visual score (VS) for assessing the AV was developed and its reliability with respect to Doppler measurements and the calcium score (ctCS) derived by multislice computed tomography was evaluated. 99 Patients with AS of various severity and 38 patients without AS were included in the analysis. Echocardiographic studies were evaluated using the new VS which includes echogenicity, thickening, localization of lesions and leaflet mobility, with a total score ranging from 0 to 11. The association of VS with ctCS and the severity of AS was analyzed. There was a significant correlation of VS with AV hemodynamic parameters and with ctCS. The cut-off value for the detection of AS of any grade was a VS of 6 (sensitivity 95%, specificity 85% for women; sensitivity 85%, specificity 88% for men). A VS of 9 for women and of 10 for men was able to predict severe AS with a high specificity (96% in women and 94% in men, AUC 0.8 and 0.86, respectively). The same cut-off values were identified for the detection of ctCS of ≥ 1600 AU and ≥ 3000 AU with a specificity of 77% and 82% (AUC 0.69 and 0.81, respectively). Assessment of aortic valve morphology can serve as an additional diagnostic tool for the detection of AS and an estimation of its severity.
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Affiliation(s)
- Olena Nemchyna
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Sajjad Soltani
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Natalia Solowjowa
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Hessische Straße 3- 4, 10115, Berlin, Germany
| | - Yuriy Hrytsyna
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Axel Unbehaun
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Hessische Straße 3- 4, 10115, Berlin, Germany
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Hessische Straße 3- 4, 10115, Berlin, Germany
| | - Julia Stein
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Christoph Knosalla
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Hessische Straße 3- 4, 10115, Berlin, Germany
| | - Andreas Hagendorff
- Department of Cardiology, Klinik und Poliklinik für Kardiologie, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Fabian Knebel
- Department of Cardiology and Angiology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Hessische Straße 3- 4, 10115, Berlin, Germany.,Department of Cardiothoracic Surgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,Department of Health Sciences and Technology, Translational Cardiovascular Technology, ETH Zurich, LFW C 13.2, Universitätstrasse 2, 8092, Zurich, Switzerland
| | - Jan Knierim
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
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23
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Wang TKM, Griffin BP, Xu B, Rodriguez LL, Popovic ZB, Gillinov MA, Pettersson GB, Desai MY. Relationships between mitral annular calcification and cardiovascular events: A meta‐analysis. Echocardiography 2020; 37:1723-1731. [DOI: 10.1111/echo.14861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/25/2020] [Accepted: 08/25/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Tom Kai Ming Wang
- Section of Cardiovascular Imaging Heart and Vascular Institute Cleveland Clinic Cleveland OH USA
| | - Brian P. Griffin
- Section of Cardiovascular Imaging Heart and Vascular Institute Cleveland Clinic Cleveland OH USA
| | - Bo Xu
- Section of Cardiovascular Imaging Heart and Vascular Institute Cleveland Clinic Cleveland OH USA
| | - Leonardo L. Rodriguez
- Section of Cardiovascular Imaging Heart and Vascular Institute Cleveland Clinic Cleveland OH USA
| | - Zoran B. Popovic
- Section of Cardiovascular Imaging Heart and Vascular Institute Cleveland Clinic Cleveland OH USA
| | - Marc A. Gillinov
- Department of Thoracic and Cardiovascular Surgery Heart and Vascular InstituteCleveland Clinic Cleveland OH USA
| | - Gosta B. Pettersson
- Department of Thoracic and Cardiovascular Surgery Heart and Vascular InstituteCleveland Clinic Cleveland OH USA
| | - Milind Y. Desai
- Section of Cardiovascular Imaging Heart and Vascular Institute Cleveland Clinic Cleveland OH USA
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24
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Non-coronary cardiac calcifications and outcomes in patients with heart failure. J Cardiol 2020; 77:83-87. [PMID: 32826139 DOI: 10.1016/j.jjcc.2020.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/27/2020] [Accepted: 07/13/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Calcium deposits on heart valves are considered a local manifestation of atherosclerosis and are associated with poor cardiovascular outcomes. The clinical significance of cardiac calcifications among heart failure (HF) patients, as assessed by echocardiography, is unknown. This study evaluated associations of cardiac calcifications with mortality and hospital admissions in this specific population. METHODS Medical records of all patients who initiated ambulatory surveillance at our HF clinic during 2011-2018 were reviewed. Calcifications in the aortic valve, aortic root, or the mitral valve were evaluated. Patients with moderate to severe regurgitation or stenosis of the aortic or mitral valves were excluded. The primary endpoint was the composite of long-term all-cause mortality and HF hospitalizations. Secondary endpoints were long-term all-cause mortality and more than one hospitalization due to HF. RESULTS This retrospective study included 814 patients (mean age 70.9 ± 13 years, 63.2% male). Of the total cohort, 350 (43%) had no cardiac calcifications and 464 (57%) had at least 1 calcified site. Considering the patients with no calcification as the reference group yielded a higher adjusted odds ratios for the composite endpoint, all-cause death, and recurrent HF hospitalizations, among patients with any cardiac calcification (OR = 1.68, 95%CI = 1.1-2.5, p = 0.01, OR=1.61, 95%CI = 1.1-2.3, p < 0.01, and OR = 1.50, 95%CI = 1.1-2.2, p < 0.01, respectively). CONCLUSIONS We found an independent association between cardiac calcifications and the risk of death and HF hospitalizations among ambulatory HF patients. Cardiac calcifications evaluated during routine echocardiography may contribute to the risk stratification of patients with HF.
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25
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Carrai P, Camarri S, Pondrelli CR, Gonnelli S, Caffarelli C. Calcification of Cardiac Valves in Metabolic Bone Disease: An Updated Review of Clinical Studies. Clin Interv Aging 2020; 15:1085-1095. [PMID: 32764895 PMCID: PMC7367930 DOI: 10.2147/cia.s244063] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 05/18/2020] [Indexed: 12/14/2022] Open
Abstract
Epidemiological and clinical data have suggested the existence of a relationship between cardiovascular diseases and metabolic bone disease. Several studies have demonstrated that heart valve calcification presents substantial similarities with that of bone. Literature data indicate that there are many active processes which promote osteogenesis and loss of mineralization inhibitors that lead to the deposition of extracellular matrix and proteins of bone tissue in cardiac valves. This review aimed to synthesize the available data in order to allow a better understanding of the relationship between osteoporosis or other metabolic bone diseases, such as primary hyperparathyroidism, and valvular calcification in humans. Electronic databases of Pubmed-Medline, Cochrane Library, and SCOPUS from inception to March 31, 2019 were searched. The full set of the articles potentially eligible were carefully assessed and reviewed. Finally, 23 studies were eligible and included in the systematic review. The majority of studies reported that osteoporosis and/or osteopenia were independent risk factors for valvular calcifications, even after adjusting for common cardiovascular risk factors. This suggests that this relationship is not only due to the presence of common cardiovascular risk factors but rather to underlying biological factors that connect them. Instead, regarding the association between primary hyperparathyroidism and valve calcification, conflicting data were found in the literature. To sum up, most of the literature data confirm that cardiac valve calcification processes are strongly influenced by alterations in bone metabolism. In particular, the patients with osteoporosis or primary hyperparathyroidism have an acceleration in the process of valvular calcification. Additional studies are needed to specifically address the mechanisms by which metabolic bone diseases could influence cardiac valve calcification.
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Affiliation(s)
- Paolo Carrai
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Silvia Camarri
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | | | - Stefano Gonnelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Carla Caffarelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
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26
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Massera D, Kizer JR, Dweck MR. Mechanisms of mitral annular calcification. Trends Cardiovasc Med 2020; 30:289-295. [DOI: 10.1016/j.tcm.2019.07.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/26/2019] [Accepted: 07/30/2019] [Indexed: 01/27/2023]
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27
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Li Y, Lu Z, Li X, Huang J, Wu Q. Mitral annular calcification is associated with atrial fibrillation and major cardiac adverse events in atrial fibrillation patients: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e17548. [PMID: 31689756 PMCID: PMC6946188 DOI: 10.1097/md.0000000000017548] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 07/23/2019] [Accepted: 09/18/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The incidence of atrial fibrillation (AF) varies from 5.4% to 47.1% in patients with mitral annulus calcification (MAC). We conducted a systematic review and meta-analysis on the association between MAC and AF, as well as the relation between MAC and major cardiac adverse events (MACEs) in AF patients. METHODS We conducted comprehensive search for literature on associations between MAC and AF using the following databases: MEDLINE, PubMed, Embase, and the Web of Science. The pooled odds ratio (OR) or relative risk and the corresponding 95% confidence intervals (CIs) were calculated to assess the relationship between MAC and AF, as well as the rates of MACEs in AF patients with or without MAC. RESULTS Thirteen studies met our eligibility criteria on associations between MAC and AF, including 6232 patients with MAC and 15,199 patients without MAC. Moreover, 5 studies met our eligibility criteria on the rates of MACEs in AF patients with or without MAC. The pooled analysis demonstrated a statistically significant increased risk of development of incident AF in patients with MAC than those without MAC (random effects OR: 2.34; 95% CI: 1.91, 2.85; P = .000). And the pooled analysis demonstrated a statistically significant increased risk of development of MACEs in AF patients with MAC (random effects OR: 2.34; 95% CI: 1.24, 4.41; P = .009). CONCLUSION MAC was independently associated with AF and AF patients with MAC were at greater risk for cardiovascular and cerebrovascular events.
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Affiliation(s)
- Yimin Li
- Department of Cardiology, Second Affiliated Hospital of Nanchang University, Nanchang
- Department of Cardiology, Affiliated Brain Hospital of Nanjing Medical University (Chest Branch), Nanjing, China
| | - Zhiping Lu
- Department of Cardiology, Affiliated Brain Hospital of Nanjing Medical University (Chest Branch), Nanjing, China
| | - Xiangyu Li
- Department of Cardiology, Affiliated Brain Hospital of Nanjing Medical University (Chest Branch), Nanjing, China
| | - Jin Huang
- Department of Cardiology, Affiliated Brain Hospital of Nanjing Medical University (Chest Branch), Nanjing, China
| | - Qinghua Wu
- Department of Cardiology, Second Affiliated Hospital of Nanchang University, Nanchang
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28
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Aortic Valve Sclerosis Adds to Prediction of Short-Term Mortality in Patients with Documented Coronary Atherosclerosis. J Clin Med 2019; 8:jcm8081172. [PMID: 31387275 PMCID: PMC6722808 DOI: 10.3390/jcm8081172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/15/2019] [Accepted: 07/29/2019] [Indexed: 11/25/2022] Open
Abstract
Aims: Aortic valve sclerosis (AVSc), a non-uniform thickening of leaflets with an unrestricted opening, is characterized by inflammation, lipoprotein deposition, and matrix degradation. In the general population, AVSc predicts long-term cardiovascular mortality (+50%) even after adjustment for vascular risk factors and clinical atherosclerosis. We have hypothesized that AVSc is a risk-multiplier able to predict even short-term mortality. To address this issue, we retrospectively analyzed 90-day mortality of all patients who underwent isolated coronary artery bypass grafting (CABG) at Centro Cardiologico Monzino over a ten-year period (2006–2016). Methods: We analyzed 2246 patients and 90-day all-cause mortality was 1.5% (31 deaths). We selected only patients deceased from cardiac causes (n = 29) and compared to alive patients (n = 2215). A cardiologist classified the aortic valve as no-AVSc (n = 1352) or AVSc (n = 892). Cox linear regression and integrated discrimination improvement (IDI) analyses were used to evaluate AVSc in predicting 90-day mortality. Results: AVSc 90-day survival (97.6%) was lower than in no-AVSc (99.4%; p < 0.0001) with a hazard ratio (HR) of 4.0 (95%CI: 1.78, 9.05; p < 0.0001). The HR for AVSc, adjusted for propensity score, was 2.7 (95%CI: 1.17, 6.23; p = 0.02) and IDI statistics confirmed that AVSc significantly adds (p < 0.001) to the identification of high-risk patients than EuroSCORE II alone. Conclusion: Our data supports the hypothesis that a risk stratification strategy based on AVSc, added to ESII, may allow better recognition of patients at high-risk of short-term mortality after isolated surgical myocardial revascularization. Results from this study warrant further confirmation.
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29
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Faggiano P, Dasseni N, Gaibazzi N, Rossi A, Henein M, Pressman G. Cardiac calcification as a marker of subclinical atherosclerosis and predictor of cardiovascular events: A review of the evidence. Eur J Prev Cardiol 2019; 26:1191-1204. [DOI: 10.1177/2047487319830485] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Pompilio Faggiano
- Cardiology Division, Spedali Civili Hospital and University of Brescia, Italy
| | - Nicolò Dasseni
- Cardiology Division, Spedali Civili Hospital and University of Brescia, Italy
| | | | - Andrea Rossi
- Cardiology Division, University of Verona, Italy
| | - Michael Henein
- Department of Public Health and Clinical Medicine, Umea University, Sweden
- St George University, London, UK
- Brunel University, London, UK
| | - Gregg Pressman
- Heart and Vascular Institute, Einstein Medical Center, Philadelphia, USA
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30
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Association between monocyte to HDL cholesterol ratio and mitral annulus calcification. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.512374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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31
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Bellinge JW, Francis RJ, Majeed K, Watts GF, Schultz CJ. In search of the vulnerable patient or the vulnerable plaque: 18F-sodium fluoride positron emission tomography for cardiovascular risk stratification. J Nucl Cardiol 2018; 25:1774-1783. [PMID: 29992525 DOI: 10.1007/s12350-018-1360-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 06/18/2018] [Indexed: 02/07/2023]
Abstract
Cardiovascular disease (CVD) remains a leading cause of death. Preventative therapies that reduce CVD are most effective when targeted to individuals at high risk. Current risk stratification tools have only modest prognostic capabilities, resulting in over-treatment of low-risk individuals and under-treatment of high-risk individuals. Improved methods of CVD risk stratification are required. Molecular imaging offers a novel approach to CVD risk stratification. In particular, 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) has shown promise in the detection of both high-risk atherosclerotic plaque features and vascular calcification activity, which predicts future development of new vascular calcium deposits. The rate of change of coronary calcium scores, measured by serial computed tomography scans over a 2-year period, is a strong predictor of CVD risk. Vascular calcification activity, as measured with 18F-NaF PET, has the potential to provide prognostic information similar to consecutive coronary calcium scoring, with a single-time-point convenience. However, owing to the rapid motion and small size of the coronary arteries, new solutions are required to address the traditional limitations of PET imaging. Two different methods of coronary PET analysis have been independently proposed and here we compare their respective strengths, weaknesses, and the potential for clinical translation.
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Affiliation(s)
- Jamie W Bellinge
- Department of Cardiology, Royal Perth Hospital, 197 Wellington St, Perth, WA, 6000, Australia.
- School of Medicine, University of Western Australia, Perth, Australia.
| | - Roslyn J Francis
- School of Medicine, University of Western Australia, Perth, Australia
- Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Kamran Majeed
- Department of Cardiology, Royal Perth Hospital, 197 Wellington St, Perth, WA, 6000, Australia
- School of Medicine, University of Western Australia, Perth, Australia
| | - Gerald F Watts
- Department of Cardiology, Royal Perth Hospital, 197 Wellington St, Perth, WA, 6000, Australia
- School of Medicine, University of Western Australia, Perth, Australia
| | - Carl J Schultz
- Department of Cardiology, Royal Perth Hospital, 197 Wellington St, Perth, WA, 6000, Australia
- School of Medicine, University of Western Australia, Perth, Australia
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32
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Zhang D, Dai X, Wang C, Han K, Wang J, Dong Y, Chen J, Hou L. Aortic valve calcification and risk of stroke: A systematic review and meta-analysis. J Clin Neurosci 2018; 55:32-37. [PMID: 30041902 DOI: 10.1016/j.jocn.2018.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/04/2018] [Accepted: 07/08/2018] [Indexed: 11/22/2022]
Abstract
Aortic valve calcification (AVC) is common among aged population and reported to be associated with the risk of stroke. However, the conclusions are inconsistent among studies. We performed a rigorous meta-analysis to unravel the AVC-stroke relationship. Embase, PubMed and Cochrane library were retrieved for related cohort studies investigating the correlations between AVC and risk of stroke. The language was limited to English. We selected risk ratio (RR) and 95% confidence intervals (CIs) as the effect size. Random-effects model was used in the data synthesis. A total of 7 cohort studies were identified in our meta-analysis with 21,395 participants and 1025 strokes. We detected statistically significant correlation between AVC and stroke (RR, 1.20; 95% CI, 1.02-1.40, P = 0.02) with low heterogeneity (I2 = 6.9%, P = 0.375). Statistically significant results were detected only in the subgroup of "+" degree of adjustment (P = 0.04). Therefore, a definite relationship between AVC and risk of stroke couldn't be decided based on current available data, and more large scale prospective studies were needed to verify the AVC-stroke relationship.
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Affiliation(s)
- Danfeng Zhang
- Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Xianliang Dai
- Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai 200433, China
| | - Chaoqun Wang
- Department of Endocrinology, Changhai Hospital, Second Military Medical University, Shanghai 200003, China
| | - Kaiwei Han
- Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Junyu Wang
- Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Yan Dong
- Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Jigang Chen
- Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
| | - Lijun Hou
- Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
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33
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Mazzone C, Cioffi G, Di Nora C, Barbati G, Guidetti F, Faggiano P, Gaibazzi N, Faganello G, Borca EC, Di Lenarda A. Prognostic role of cardiac calcifications in primary prevention: A powerful marker of adverse outcome highly dependent on underlying cardiac rhythm. Int J Cardiol 2018; 258:262-268. [DOI: 10.1016/j.ijcard.2018.01.101] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 12/06/2017] [Accepted: 01/22/2018] [Indexed: 01/08/2023]
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34
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Massera D, Xu S, Bartz TM, Bortnick AE, Joachim H, Chonchol M, Owens DS, Barasch E, Gardin JM, Gottdiener JS, Robbins JR, Siscovick DS, Kizer JR. Relationship of bone mineral density with valvular and annular calcification in community-dwelling older people: The Cardiovascular Health Study. Arch Osteoporos 2017; 12:52. [PMID: 28560501 PMCID: PMC5537624 DOI: 10.1007/s11657-017-0347-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 05/06/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED Associations between bone mineral density and aortic valvular, aortic annular, and mitral annular calcification were investigated in a cross-sectional analysis of a population-based cohort of 1497 older adults. Although there was no association between continuous bone mineral density and outcomes, a significant association between osteoporosis and aortic valvular calcification in men was found. INTRODUCTION The process of cardiac calcification bears a resemblance to skeletal bone metabolism and its regulation. Experimental studies suggest that bone mineral density (BMD) and valvular calcification may be reciprocally related, but epidemiologic data are sparse. METHODS We tested the hypothesis that BMD of the total hip and femoral neck measured by dual-energy X-ray absorptiometry (DXA) is inversely associated with prevalence of three echocardiographic measures of cardiac calcification in a cross-sectional analysis of 1497 older adults from the Cardiovascular Health Study. The adjusted association of BMD with aortic valve calcification (AVC), aortic annular calcification (AAC), and mitral annular calcification (MAC) was assessed with relative risk (RR) regression. RESULTS Mean (SD) age was 76.2 (4.8) years; 58% were women. Cardiac calcification was highly prevalent in women and men: AVC, 59.5 and 71.0%; AAC 45.1 and 46.7%; MAC 42.8 and 39.5%, respectively. After limited and full adjustment for potential confounders, no statistically significant associations were detected between continuous BMD at either site and the three measures of calcification. Assessment of WHO BMD categories revealed a significant association between osteoporosis at the total hip and AVC in men (adjusted RR compared with normal BMD = 1.24 (1.01-1.53)). In graded sensitivity analyses, there were apparent inverse associations between femoral neck BMD and AVC with stenosis in men, and femoral neck BMD and moderate/severe MAC in women, but these were not significant. CONCLUSION These findings support further investigation of the sex-specific relationships between low BMD and cardiac calcification, and whether processes linking the two could be targeted for therapeutic ends.
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Affiliation(s)
- Daniele Massera
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Shuo Xu
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | | | - Anna E. Bortnick
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - H. Joachim
- University of California San Diego, San Diego, CA
| | | | | | | | | | | | | | | | - Jorge R. Kizer
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
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35
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Kianoush S, Al Rifai M, Cainzos-Achirica M, Al-Mallah MH, Tison GH, Yeboah J, Miedema MD, Allison MA, Wong ND, DeFilippis AP, Longstreth W, Nasir K, Budoff MJ, Matsushita K, Blaha MJ. Thoracic extra-coronary calcification for the prediction of stroke: The Multi-Ethnic Study of Atherosclerosis. Atherosclerosis 2017; 267:61-67. [PMID: 29100062 PMCID: PMC5705470 DOI: 10.1016/j.atherosclerosis.2017.10.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 10/02/2017] [Accepted: 10/06/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIMS Atherosclerosis is a systemic disease. We examined whether the cumulative burden of thoracic extra-coronary calcification (ECC) improves prediction of stroke, transient ischemic attack (TIA), and stroke mortality beyond traditional risk factors and coronary artery calcium (CAC). METHODS We followed a total of 6805 participants (mean age 62.1 ± 10.2 years, 47.2% male) from the Multi-Ethnic Study of Atherosclerosis (MESA) over a median of 12.1 years. The presence or absence of calcification at 4 thoracic ECC sites (mitral valve annulus, aortic valve, aortic root, and thoracic aorta) was determined from baseline cardiac-gated non-contrast CT scans. A multisite thoracic ECC score, ranging 0-4, was calculated by summing the 4 individual sites, which were treated as binary variables. Multivariable Cox proportional hazards regression models, controlled for traditional risk factors and CAC, were used to estimate hazard ratios for ischemic (primary endpoint) and hemorrhagic stroke, total stroke, TIA, and stroke mortality with increasing thoracic ECC. RESULTS With an increasing number of thoracic ECC sites, there was a significant (p < 0.05) multivariable adjusted step-wise increase in the risk for ischemic stroke (n = 184), total stroke (n = 235), and TIA (n = 85), but not hemorrhagic stroke (n = 32) and stroke mortality (n = 42). Thoracic ECC increased the c-statistic and net reclassification index beyond traditional risk factors and CAC, but the results were not significant (p > 0.10). CONCLUSIONS Although multisite thoracic ECC is independently associated with ischemic stroke, total stroke, and TIA, the incremental predictive value of thoracic ECC beyond traditional risk factors and CAC appears to be minimal.
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Affiliation(s)
- Sina Kianoush
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Mahmoud Al Rifai
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Miguel Cainzos-Achirica
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA; RTI Health Solutions, Barcelona, Spain
| | - Mouaz H Al-Mallah
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA; King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research, Saudi Arabia
| | - Geoffrey H Tison
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of Cardiology, University of California, San Francisco, CA, USA
| | - Joseph Yeboah
- Department of Heart and Vascular Center of Excellence, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Michael D Miedema
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Matthew A Allison
- Department of Family Medicine and Public Health, University of California - San Diego, San Diego, CA, USA
| | - Nathan D Wong
- Los Angeles Biomedical Research Institute, Torrance, CA, USA; University of Washington, Seattle, WA, USA
| | - Andrew P DeFilippis
- Division of Cardiovascular Medicine, University of Louisville, Jewish Hospital/Kentucky One Health, Louisville, KY, USA
| | | | - Khurram Nasir
- Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL, USA
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute, Torrance, CA, USA; University of Washington, Seattle, WA, USA
| | - Kunihiro Matsushita
- Departments of Epidemiology and Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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Relationship between cardiac calcification and left ventricular hypertrophy in patients with chronic kidney disease at hemodialysis initiation. Heart Vessels 2017; 32:1109-1116. [PMID: 28324126 DOI: 10.1007/s00380-017-0969-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/10/2017] [Indexed: 01/14/2023]
Abstract
Coronary artery calcification (CAC), cardiac valve calcification (CVC) and left ventricular hypertrophy (LVH) are frequently observed in chronic kidney disease (CKD) patients. These abnormalities significantly affect morbidity and mortality. The aim of this study was to investigate the relationship between CAC, CVC and LVH in CKD patients. This study included 96 patients who were hospitalized and initiated hemodialysis between December 2011 and July 2014 at our five institutions. Multi-detector computed tomography for the quantification of CAC using the Agatston score and transthoracic echocardiography for assessing CVC and LVH were performed for all patients included in the study. We semi-quantitatively evaluated the severity of CVC as a valvular calcification score. We also assessed the presence of LVH in patients with CAC and/or CVC. Among the 96 patients, the prevalence of CAC was 81.3% and CVC was 65.0%. The severity of CAC was closely and significantly associated with that of CVC. The percentage of patients with LVH was the greatest in those with both severe CAC and CVC. CAC was significantly more severe in patients with concentric hypertrophy compared to those with normal geometry. At the initiation of hemodialysis, most CKD patients had CAC, CVC and LVH. In addition, cardiac calcification was significantly associated with LVH in these patients.
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Lu MLR, Gupta S, Romero-Corral A, Matejková M, De Venecia T, Obasare E, Bhalla V, Pressman GS. Cardiac Calcifications on Echocardiography Are Associated with Mortality and Stroke. J Am Soc Echocardiogr 2016; 29:1171-1178. [DOI: 10.1016/j.echo.2016.08.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Indexed: 10/20/2022]
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Kajimoto K, Takano T. Role of functional mitral regurgitation in heart failure with preserved ejection fraction: an unrecognized protagonist?: reply. Eur J Heart Fail 2016; 19:291. [PMID: 27813322 DOI: 10.1002/ejhf.677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 09/12/2016] [Accepted: 09/16/2016] [Indexed: 11/08/2022] Open
Affiliation(s)
- Katsuya Kajimoto
- Division of Cardiology, Sekikawa Hospital, 1-4-1, Nishi-Nippori, Arakawa-ku, Tokyo, 116-0013, Japan
| | - Teruo Takano
- Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
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Senguttuvan NB, Kumar S, Lee WS, Mishra S, Cho JH, Kwon JE, Hyeon SH, Jeong YS, Won H, Shin SY, Lee KJ, Kim TH, Kim CJ, Kim SW. Plaque Vulnerability as Assessed by Radiofrequency Intravascular Ultrasound in Patients with Valvular Calcification. PLoS One 2016; 11:e0165885. [PMID: 27806099 PMCID: PMC5091909 DOI: 10.1371/journal.pone.0165885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 09/29/2016] [Indexed: 11/30/2022] Open
Abstract
Background Cardiac valvular calcification is associated with the overall coronary plaque burden and considered an independent cardiovascular risk and prognostic factor. The purpose of this study was to evaluate the relationship between the presence of valvular calcification and plaque morphology and/or vulnerability. Methods Transthoracic echocardiography was used to assess valvular calcification in 280 patients with coronary artery disease who underwent radiofrequency intravascular ultrasound (Virtual Histology IVUS, VH-IVUS). A propensity score–matched cohort of 192 patients (n = 96 in each group) was analyzed. Thin-capped fibroatheroma (TCFA) was defined as a necrotic core (NC) >10% of the plaque area with a plaque burden >40% and NC in contact with the lumen for ≥3 image slices. A remodeling index (lesion/reference vessel area) >1.05 was considered to be positive. Results Patients were divided into two groups: any calcification in at least one valve (152 patients) vs. no detectable valvular calcification (128 patients). Groups were similar in terms of age, risk factors, clinical diagnosis, and angiographic analysis after propensity score-matched analysis. Gray-scale IVUS analysis showed that the vessel size, plaque burden, minimal lumen area, and remodeling index were similar. By VH-IVUS, % NC and % dense calcium (DC) were greater in patients with valvular calcification (p = 0.024, and p = 0.016, respectively). However, only % DC was higher at the maximal NC site by propensity score-matched analysis (p = 0.029). The frequency of VH-TCFA occurrence was higher depending on the complexity (p = 0.0064) and severity (p = 0.013) of valvular calcification. Conclusions There is a significant relationship between valvular calcifications and VH-IVUS assessment of TCFAs. Valvular calcification indicates a greater atherosclerosis disease complexity (increased calcification of the coronary plaque) and vulnerable coronary plaques (higher incidence of VH-TCFA).
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Affiliation(s)
| | - Sharath Kumar
- Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea
| | - Wang-Soo Lee
- Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea
- * E-mail:
| | - Sundeep Mishra
- All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Jun Hwan Cho
- Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea
| | - Jee Eun Kwon
- Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea
| | - Seong Hyeop Hyeon
- Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea
| | - Yun Sang Jeong
- Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea
| | - Hoyoun Won
- Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea
| | - Seung Yong Shin
- Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea
| | - Kwang Je Lee
- Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea
| | - Tae Ho Kim
- Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea
| | - Chee Jeong Kim
- Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea
| | - Sang-Wook Kim
- Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea
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Bos D, Bozorgpourniazi A, Mutlu U, Kavousi M, Vernooij MW, Moelker A, Franco OH, Koudstaal PJ, Ikram MA, van der Lugt A. Aortic Valve Calcification and Risk of Stroke. Stroke 2016; 47:2859-2861. [DOI: 10.1161/strokeaha.116.015200] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 09/07/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
It remains uncertain whether aortic valve calcification (AVC) is a risk factor for stroke.
Methods—
From the population-based Rotterdam Study, 2471 participants (mean age: 69.6 years; 51.8% women) underwent computed tomography to quantify AVC. We assessed prevalent stroke and continuously monitored the remaining participants for the incidence of stroke. Logistic and Cox regression models were used to investigate associations of AVC with prevalent stroke and risk of incident stroke.
Results—
AVC was present in 33.1% of people. At baseline, 97 participants had ever suffered a stroke. During 18 665 person-years of follow-up (mean: 7.9 years), 135 people experienced a first-ever stroke. The presence of AVC was not associated with prevalent stroke (fully adjusted odds ratio: 0.97 (95% confidence interval, 0.61–1.53]) or with an increased risk of stroke (fully adjusted hazard ratio: 0.99 (95% confidence interval, 0.69–1.44]).
Conclusions—
Although AVC is a common finding in middle-aged and elderly community-dwelling people, our results suggest that AVC is not associated with an increased risk of stroke.
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Affiliation(s)
- Daniel Bos
- From the Department of Radiology and Nuclear Medicine (D.B., A.B., M.W.V., A.M., M.A.I., A.v.d.L.), Department of Epidemiology (D.B., U.M., M.K., M.W.V., O.H.F., M.A.I.), and Department of Neurology (P.J.K., M.A.I.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (D.B.)
| | - Atefeh Bozorgpourniazi
- From the Department of Radiology and Nuclear Medicine (D.B., A.B., M.W.V., A.M., M.A.I., A.v.d.L.), Department of Epidemiology (D.B., U.M., M.K., M.W.V., O.H.F., M.A.I.), and Department of Neurology (P.J.K., M.A.I.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (D.B.)
| | - Unal Mutlu
- From the Department of Radiology and Nuclear Medicine (D.B., A.B., M.W.V., A.M., M.A.I., A.v.d.L.), Department of Epidemiology (D.B., U.M., M.K., M.W.V., O.H.F., M.A.I.), and Department of Neurology (P.J.K., M.A.I.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (D.B.)
| | - Maryam Kavousi
- From the Department of Radiology and Nuclear Medicine (D.B., A.B., M.W.V., A.M., M.A.I., A.v.d.L.), Department of Epidemiology (D.B., U.M., M.K., M.W.V., O.H.F., M.A.I.), and Department of Neurology (P.J.K., M.A.I.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (D.B.)
| | - Meike W. Vernooij
- From the Department of Radiology and Nuclear Medicine (D.B., A.B., M.W.V., A.M., M.A.I., A.v.d.L.), Department of Epidemiology (D.B., U.M., M.K., M.W.V., O.H.F., M.A.I.), and Department of Neurology (P.J.K., M.A.I.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (D.B.)
| | - Adriaan Moelker
- From the Department of Radiology and Nuclear Medicine (D.B., A.B., M.W.V., A.M., M.A.I., A.v.d.L.), Department of Epidemiology (D.B., U.M., M.K., M.W.V., O.H.F., M.A.I.), and Department of Neurology (P.J.K., M.A.I.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (D.B.)
| | - Oscar H. Franco
- From the Department of Radiology and Nuclear Medicine (D.B., A.B., M.W.V., A.M., M.A.I., A.v.d.L.), Department of Epidemiology (D.B., U.M., M.K., M.W.V., O.H.F., M.A.I.), and Department of Neurology (P.J.K., M.A.I.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (D.B.)
| | - Peter J. Koudstaal
- From the Department of Radiology and Nuclear Medicine (D.B., A.B., M.W.V., A.M., M.A.I., A.v.d.L.), Department of Epidemiology (D.B., U.M., M.K., M.W.V., O.H.F., M.A.I.), and Department of Neurology (P.J.K., M.A.I.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (D.B.)
| | - M. Arfan Ikram
- From the Department of Radiology and Nuclear Medicine (D.B., A.B., M.W.V., A.M., M.A.I., A.v.d.L.), Department of Epidemiology (D.B., U.M., M.K., M.W.V., O.H.F., M.A.I.), and Department of Neurology (P.J.K., M.A.I.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (D.B.)
| | - Aad van der Lugt
- From the Department of Radiology and Nuclear Medicine (D.B., A.B., M.W.V., A.M., M.A.I., A.v.d.L.), Department of Epidemiology (D.B., U.M., M.K., M.W.V., O.H.F., M.A.I.), and Department of Neurology (P.J.K., M.A.I.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (D.B.)
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Konety SH, Koene RJ, Norby FL, Wilsdon T, Alonso A, Siscovick D, Sotoodehnia N, Gottdiener J, Fox ER, Chen LY, Adabag S, Folsom AR. Echocardiographic Predictors of Sudden Cardiac Death: The Atherosclerosis Risk in Communities Study and Cardiovascular Health Study. Circ Cardiovasc Imaging 2016; 9:e004431. [PMID: 27496550 PMCID: PMC5010094 DOI: 10.1161/circimaging.115.004431] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 06/23/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND This study assessed the echocardiographic predictors of sudden cardiac death (SCD) within 2 population-based cohorts. METHODS AND RESULTS Echocardiograms were obtained on 2383 participants (1993-1995) from the ARIC study (Atherosclerosis Risk in Communities; 100% black) and 5366 participants (1987-1989 and 1994-1995) from the CHS (Cardiovascular Health Study). The main outcome was physician-adjudicated SCD. We used Cox proportional-hazards models with incident coronary heart disease and heart failure as time-dependent covariates to assess the association between echocardiographic variables and SCD, adjusting for Framingham risk score variables, coronary heart disease, and renal function. Cohort-specific results were meta-analyzed. During a median follow-up of 7.3 and 13.1 years, 44 ARIC study participants and 275 CHS participants had SCD, respectively. In the meta-analyzed results, the adjusted hazard ratios (95% confidence intervals) for predictors of SCD were 3.07 (2.29-4.11) for reduced left ventricular ejection fraction; 1.85 (1.36-2.52) for mitral annular calcification; 1.64 (1.07-2.51) for mitral E/A >1.5, and 1.52 (1.14-2.02) for mitral E/A <0.7 (versus mitral E/A 0.7-1.5); 1.30 (1.15-1.48) per 1 SD increase in left ventricular mass; and 1.15 (1.02-1.30) per 1 SD increase in left atrial diameter. A receiver-operating characteristic model for prediction of SCD using Framingham risk score variables had a C statistic of 0.61 for ARIC study and 0.67 for CHS; the full multivariable model including all echocardiographic variables had a C statistic of 0.76 for ARIC study and 0.74 for CHS. CONCLUSIONS In addition to reduced left ventricular ejection fraction, we identified other echocardiographic-derived variables predictive for SCD that provided incremental value compared with clinical risk factors.
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Affiliation(s)
- Suma H Konety
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.).
| | - Ryan J Koene
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Faye L Norby
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Tony Wilsdon
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Alvaro Alonso
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - David Siscovick
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Nona Sotoodehnia
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - John Gottdiener
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Ervin R Fox
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Lin Y Chen
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Selcuk Adabag
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Aaron R Folsom
- From the Cardiovascular Division (S.H.K., R.J.K., L.Y.C.) and Division of Epidemiology and Community Health (F.L.N., A.R.F.), University of Minnesota, Minneapolis; Department of Biostatistics (T.W.), Department of Epidemiology (D.S., N.S.), and Cardiovascular Health Research Unit, Department of Medicine (D.S., N.S.), University of Washington, Seattle; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); University of Maryland Hospital, Baltimore (J.G.); Division of Cardiology, University of Mississippi, Jackson (E.R.F.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
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Bortnick AE, Bartz TM, Ix JH, Chonchol M, Reiner A, Cushman M, Owens D, Barasch E, Siscovick DS, Gottdiener JS, Kizer JR. Association of inflammatory, lipid and mineral markers with cardiac calcification in older adults. Heart 2016; 102:1826-1834. [PMID: 27411840 DOI: 10.1136/heartjnl-2016-309404] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/26/2016] [Accepted: 05/27/2016] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Calcification of the aortic valve and adjacent structures involves inflammatory, lipid and mineral metabolism pathways. We hypothesised that circulating biomarkers reflecting these pathways are associated with cardiac calcification in older adults. METHODS We investigated the associations of various biomarkers with valvular and annular calcification in the Cardiovascular Health Study. Of the 5888 participants, up to 3585 were eligible after exclusions for missing biomarker, covariate or echocardiographic data. We evaluated analytes reflecting lipid (lipoprotein (Lp) (a), Lp-associated phospholipase A2 (LpPLA2) mass and activity), inflammatory (interleukin-6, soluble (s) CD14) and mineral metabolism (fetuin-A, fibroblast growth factor (FGF)-23) pathways that were measured within 5 years of echocardiography. The relationships of plasma biomarkers with aortic valve calcification (AVC), aortic annular calcification (AAC) and mitral annular calcification (MAC) were assessed with relative risk (RR) regression. RESULTS Calcification was prevalent: AVC 59%, AAC 45% and MAC 41%. After adjustment, Lp(a), LpPLA2 mass and activity and sCD14 were positively associated with AVC. RRs for AVC per SD (95% CI) were as follows: Lp(a), 1.051 (1.022 to 1.081); LpPLA2 mass, 1.036 (1.006 to 1.066) and LpPLA2 activity, 1.037 (1.004 to 1.071); sCD14, 1.039 (1.005 to 1.073). FGF-23 was positively associated with MAC, 1.040 (1.004 to 1.078) and fetuin-A was negatively associated, 0.949 (0.911 to 0.989). No biomarkers were significantly associated with AAC. CONCLUSION This study shows novel associations of circulating FGF-23 and fetuin-A with MAC, and LpPLA2 and sCD14 with AVC, confirming that previously reported for Lp(a). Further investigation of Lp and inflammatory pathways may provide added insight into the aetiology of AVC, while study of phosphate regulation may illuminate the pathogenesis of MAC.
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Affiliation(s)
- Anna E Bortnick
- Cardiology Division, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Traci M Bartz
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Joachim H Ix
- Department of Medicine, and the Division of Preventive Medicine, Department of Family and Preventive Medicine, University of California, and Nephrology Section, Veteran Affairs San Diego Health Care System, San Diego, California, USA
| | - Michel Chonchol
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado, Denver, Aurora, Colorado, USA
| | - Alexander Reiner
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Mary Cushman
- Departments of Pathology and Biochemistry, University of Vermont, Burlington, Vermont, USA
| | - David Owens
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Eddy Barasch
- Department of Research and Education, St. Francis Hospital, The Heart Center, Roslyn, New York, USA
| | | | - John S Gottdiener
- Division of Cardiovascular Medicine, Department of Cardiology, University of Maryland, Baltimore, Maryland, USA
| | - Jorge R Kizer
- Cardiology Division, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
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43
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Rezaeian P, Miller PE, Haberlen SA, Razipour A, Bahrami H, Castillo R, Witt MD, Kingsley L, Palella FJ, Nakanishi R, Matsumoto S, Alani A, Jacobson LP, Post WS, Budoff MJ. Extra-coronary calcification (aortic valve calcification, mitral annular calcification, aortic valve ring calcification and thoracic aortic calcification) in HIV seropositive and seronegative men: Multicenter AIDS Cohort Study. J Cardiovasc Comput Tomogr 2016; 10:229-236. [PMID: 26949197 DOI: 10.1016/j.jcct.2016.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 02/08/2016] [Accepted: 02/22/2016] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Previous studies have demonstrated an association between HIV infection and coronary artery disease (CAD); little is known about potential associations between HIV infection and extra-coronary calcification (ECC). METHODS We analyzed 621 HIV infected (HIV+) and 384 HIV uninfected (HIV-) men from the Multicenter AIDS Cohort Study who underwent non-contrast computed tomography (CT) from 2010-2013. Agatston scores were calculated for mitral annular calcification (MAC), aortic valve calcification (AVC), aortic valve ring calcification (AVRC), and thoracic aortic calcification (TAC). The associations between HIV infection and the presence of each type of ECC (score > 0) were evaluated by multivariable logistic regression. We also evaluated the association of ECC with inflammatory biomarker levels and coronary plaque morphology. RESULTS Among HIV+ and HIV- men, the age-standardized prevalences were 15% for TAC (HIV+ 14%/HIV- 16%), 10% for AVC (HIV+ 11%/HIV- 8%), 24% for AVRC (HIV+ 23% HIV- 24%), and 5% for MAC (HIV+ 7%/HIV- 3%). After adjustment, HIV+ men had 3-fold greater odds of MAC compared to HIV- men (OR = 3.2, 95% CI: 1.5-6.7), and almost twice the odds of AVC (1.8, 1.1-2.9). HIV serostatus was not associated with TAC or AVRC. AVRC was associated with higher Il-6 and sCD163 levels. TAC was associated with higher ICAM-1, TNF-α RII, and Il-6 levels. AVC and AVRC calcification were associated with presence of non-calcified plaque in HIV+ but not HIV- men. CONCLUSION HIV infection is an independent predictor of MAC and AVC. Whether these calcifications predict mortality in HIV+ patients deserves further investigation.
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Affiliation(s)
- Panteha Rezaeian
- Department of Family Medicine, Loma Linda University School of Medicine; Loma Linda, CA.,Division of Cardiology- Los Angeles Biomedical Institute at Harbor UCLA Medical Center; Torrance, CA
| | - P Elliott Miller
- Department of Medicine, Johns Hopkins University School of Medicine; Baltimore, MD
| | - Sabina A Haberlen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; Baltimore, MD
| | - Aryabod Razipour
- Division of Cardiology- Los Angeles Biomedical Institute at Harbor UCLA Medical Center; Torrance, CA
| | - Hossein Bahrami
- Division of Cardiology and Stanford Cardiovascular Institute, Stanford University; Stanford, CA
| | - Romeo Castillo
- Department of Family Medicine, Loma Linda University School of Medicine; Loma Linda, CA
| | - Mallory D Witt
- Division of HIV Medicine- Los Angeles Biomedical Institute at Harbor UCLA Medical Center; Torrance, CA
| | | | - Frank J Palella
- Northwestern University Feinberg School of Medicine; Chicago, IL
| | - Rine Nakanishi
- Division of Cardiology- Los Angeles Biomedical Institute at Harbor UCLA Medical Center; Torrance, CA
| | - Suguru Matsumoto
- Division of Cardiology- Los Angeles Biomedical Institute at Harbor UCLA Medical Center; Torrance, CA
| | - Anas Alani
- Division of Cardiology, University of Florida; Gainesville, FL
| | - Lisa P Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; Baltimore, MD
| | - Wendy S Post
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; Baltimore, MD.,Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine; Baltimore, MD
| | - Matthew J Budoff
- Division of Cardiology- Los Angeles Biomedical Institute at Harbor UCLA Medical Center; Torrance, CA
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Tison GH, Guo M, Blaha MJ, McClelland RL, Allison MA, Szklo M, Wong ND, Blumenthal RS, Budoff MJ, Nasir K. Multisite extracoronary calcification indicates increased risk of coronary heart disease and all-cause mortality: The Multi-Ethnic Study of Atherosclerosis. J Cardiovasc Comput Tomogr 2015; 9:406-14. [PMID: 26043963 PMCID: PMC4582663 DOI: 10.1016/j.jcct.2015.03.012] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 03/14/2015] [Accepted: 03/30/2015] [Indexed: 02/09/2023]
Abstract
BACKGROUND Cardiovascular calcification outside of the coronary tree, known as extracoronary calcification (ECC), is highly prevalent, often occurs concurrently in multiple sites, and yet its prognostic value is unclear. OBJECTIVE To determine whether multisite ECC is associated with coronary heart disease (CHD) events, CHD mortality, and all-cause mortality. METHODS We evaluated 5903 participants from the Multi-Ethnic Study of Atherosclerosis without diabetes who underwent CT imaging for calcification of the aortic valve, aortic root, mitral valve, and thoracic aorta. Participants were followed for 10.3 years. Multivariable adjusted hazard ratios estimated risk of outcomes for increasing numbers of ECC sites (0, 1, 2, 3, and 4), and receiver operator characteristic analysis assessed model discrimination. RESULTS Prevalence of any ECC was 45%; median age was 62 years. Compared with those without ECC, those with ECC in 4 sites had increased hazards of 4.5, 7.1 and 2.3 for CHD events, CHD mortality, and all-cause mortality, respectively, independent of traditional risk factors (TRF; all P ≤ .05), and had ≥2-fold increased hazards for outcomes independent of coronary artery calcification (CAC). Each additional site of ECC was positively associated with each outcome in a graded fashion. When added to TRF, ECC significantly increased the area under the receiver operator characteristic curve for all outcomes and modestly increased the area under the curve for mortality beyond TRF + CAC (0.799 to 0.802; P = .03). CONCLUSION Increasing multisite ECC has a graded association with higher CHD and mortality risk, contributing information beyond TRF. Multisite ECC incidentally identified on imaging can be used to improve individualized risk prediction.
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Affiliation(s)
- Geoffrey H. Tison
- University of California, San Francisco, Division of Cardiology, San Francisco; CA, USA
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins Hospital; Baltimore, MD, USA
| | - Mengye Guo
- University of Washington, Department of Biostatistics; Seattle, Washington USA
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins Hospital; Baltimore, MD, USA
| | - Robyn L. McClelland
- University of Washington, Department of Biostatistics; Seattle, Washington USA
| | - Matthew A. Allison
- University of California, San Diego, Division of Preventive Medicine, Department of Family and Preventive Medicine; San Diego, CA, USA
| | - Moyses Szklo
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University; Baltimore, MD, USA
| | - Nathan D. Wong
- Division of Cardiology, University of California, Irvine; Irvine, CA, USA
| | - Roger S. Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins Hospital; Baltimore, MD, USA
| | - Matthew J. Budoff
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA; Torrance, CA, USA
| | - Khurram Nasir
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins Hospital; Baltimore, MD, USA
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Mantovani A, Pernigo M, Bergamini C, Bonapace S, Lipari P, Valbusa F, Bertolini L, Zenari L, Pichiri I, Dauriz M, Zoppini G, Barbieri E, Byrne CD, Bonora E, Targher G. Heart valve calcification in patients with type 2 diabetes and nonalcoholic fatty liver disease. Metabolism 2015; 64:879-87. [PMID: 25957758 DOI: 10.1016/j.metabol.2015.04.003] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 04/03/2015] [Accepted: 04/20/2015] [Indexed: 12/22/2022]
Abstract
PURPOSE Aortic valve sclerosis (AVS) and mitral annulus calcification (MAC) are two powerful predictors of adverse cardiovascular outcomes in patients with type 2 diabetes, but the etiology of valvular calcification is uncertain. Nonalcoholic fatty liver disease (NAFLD) is an emerging cardiovascular risk factor and is very common in type 2 diabetes, but whether NAFLD is associated with valvular calcification in this group of patients is presently unknown. METHODS We undertook a cross-sectional study of 247 consecutive type 2 diabetic outpatients with no previous history of heart failure, valvular heart diseases (aortic stenosis, mitral stenosis, moderate or severe aortic and mitral regurgitation) or hepatic diseases. Presence of MAC and AVS was detected by echocardiography. NAFLD was diagnosed by ultrasonography. RESULTS Overall, 139 (56.3%) patients had no heart valve calcification (HVC-0), 65 (26.3%) patients had one valve affected (HVC-1) and 43 (17.4%) patients had both valves affected (HVC-2). 175 (70.8%) patients had NAFLD and the prevalence of this disease markedly increased in patients with HVC-2 compared with either HVC-1 or HVC-0 (86.1% vs. 83.1% vs. 60.4%, respectively; p < 0.001). NAFLD was significantly associated with AVS and/or MAC (unadjusted-odds ratio 3.51, 95% CI 1.89-6.51, p < 0.001). Adjustments for age, sex, waist circumference, smoking, blood pressure, hemoglobin A1c, LDL-cholesterol, kidney function parameters, medication use and echocardiographic variables did not appreciably weaken this association (adjusted-odds ratio 2.70, 95% CI 1.23-7.38, p < 0.01). CONCLUSIONS Our results show that NAFLD is an independent predictor of cardiac calcification in both the aortic and mitral valves in patients with type 2 diabetes.
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Affiliation(s)
- Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Matteo Pernigo
- Section of Cardiology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Corinna Bergamini
- Section of Cardiology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Stefano Bonapace
- Division of Cardiology, "Sacro Cuore" Hospital, Negrar (VR) Italy
| | - Paola Lipari
- Division of Cardiology, "Sacro Cuore" Hospital, Negrar (VR) Italy
| | - Filippo Valbusa
- Division of General Medicine and Diabetes Unit "Sacro Cuore" Hospital, Negrar (VR) Italy
| | - Lorenzo Bertolini
- Division of General Medicine and Diabetes Unit "Sacro Cuore" Hospital, Negrar (VR) Italy
| | - Luciano Zenari
- Division of General Medicine and Diabetes Unit "Sacro Cuore" Hospital, Negrar (VR) Italy
| | - Isabella Pichiri
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Marco Dauriz
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Giacomo Zoppini
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Enrico Barbieri
- Division of Cardiology, "Sacro Cuore" Hospital, Negrar (VR) Italy
| | - Christopher D Byrne
- Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Enzo Bonora
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Giovanni Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
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Saha SA, Beatty AL, Mishra RK, Whooley MA, Schiller NB. Usefulness of an Echocardiographic Composite Cardiac Calcium Score to Predict Death in Patients With Stable Coronary Artery Disease (from the Heart and Soul Study). Am J Cardiol 2015; 116:50-8. [PMID: 25963223 DOI: 10.1016/j.amjcard.2015.03.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 03/19/2015] [Accepted: 03/19/2015] [Indexed: 10/23/2022]
Abstract
Mitral annular calcium and aortic valve sclerosis on transthoracic echocardiography (TTE) are independently associated with cardiovascular (CV) events in patients with coronary artery disease (CAD). However, the prognostic value of calcific deposits at multiple sites is unknown. We performed TTEs in a prospective cohort of 595 outpatients with stable CAD and graded the severity of calcific deposition at 6 sites: mitral annulus, aortic valve, aortic ring, sinotubular junction, papillary muscle tip, and left main coronary artery. For each site with moderate calcific deposition or greater, 1 point was given to generate a composite cardiac calcium score (maximum of 6). The primary end point was the occurrence of CV events-a composite of death, myocardial infarction, stroke, transient ischemic attack, and heart failure. The association of the composite calcium score with CV events was evaluated using multivariate Cox proportional hazards models. Over a median follow-up of 4.2 years, 205 CV events occurred. Participants with a composite calcium score ≥2 had a higher risk of CV events (11.1 events/100 person-years) than those with a score of 0 (5.5 events/100 person-years, unadjusted hazard ratio [HR] 2.01, p <0.001), but this association was not significant after multivariate adjustment. The risk of death was higher in participants with a composite calcium score of ≥2 (8.9 events/100 person-years) versus those with a score of 0 (3.6 events/100 person-years, unadjusted HR 2.51, p <0.001). After adjustment for age, diabetes mellitus, previous coronary revascularization, diastolic blood pressure, estimated glomerular filtration rate, and serum phosphorus level, the risk of death remained higher in participants with a composite calcium score of ≥2 compared with those with a score of 0 (adjusted HR 1.76, 95% confidence interval 1.10 to 2.81, p = 0.02). In conclusion, a simple TTE-derived composite cardiac calcium score was independently predictive of death in patients with pre-existing CAD.
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47
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Prognostic Value of Echocardiographic Calcium Score in Patients With a Clinical Indication for Stress Echocardiography. JACC Cardiovasc Imaging 2015; 8:389-396. [DOI: 10.1016/j.jcmg.2014.10.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 10/28/2014] [Indexed: 01/15/2023]
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48
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Gardin JM. Can Calcium Supplementation Improve Stress Echocardiography? JACC Cardiovasc Imaging 2015; 8:397-399. [DOI: 10.1016/j.jcmg.2014.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 12/17/2014] [Accepted: 12/18/2014] [Indexed: 11/26/2022]
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Gaibazzi N, Baldari C, Faggiano P, Albertini L, Faden G, Pigazzani F, Rossi C, Reverberi C. Cardiac calcium score on 2D echo: correlations with cardiac and coronary calcium at multi-detector computed tomography. Cardiovasc Ultrasound 2014; 12:43. [PMID: 25352208 PMCID: PMC4219088 DOI: 10.1186/1476-7120-12-43] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 10/09/2014] [Indexed: 01/01/2023] Open
Abstract
Background To test the hypothesis that a semi-quantitative echocardiographic calcium score (eCS) significantly correlates with cardiac calcium measured by coronary computed tomography angiography (CCTA) and, secondarily, severe coronary artery calcifications and stenosis. Methods This is a retrospective, observational study, conducted in a tertiary centre. eCS was compared with CCTA scores of non-coronary cardiac calcium (nCACS), coronary cardiac calcium (CACS) and number of diseased coronary vessels, in 141 subjects without known coronary artery disease (CAD), who underwent both echocardiography and CCTA for clinical reasons. Results Age, prevalence of hypertension and all measures of calcium (eCS, nCACS and CACS) differed significantly between the no-CAD and CAD subgroups. eCS was positively correlated with nCACS (Spearman rho = 0.64, p < 0.0001), CACS (rho = 0.46, p < 0.01) and weakly with the number of diseased coronary vessels (rho = 0.28, p < 0.05). eCS and nCACS had similar area under the curve (AUC) for the prediction of severe CACS (≥400) (0.77, 95% CI 0.68-0.86 and 0.79, 95% CI 0.72-0.88) or obstructive CAD (0.63, 95% CI 0.54-0.72 and 0.63, 95% CI 0.55-0.73). Conclusions eCS, a calcium score easily obtainable during standard echocardiography, is moderately to strongly correlated with nCACS by CCTA. The full eCS score correlates with nCACS better than its single components. It correlates with CACS and predicts severe coronary calcification (CACS > 400), a known predictor of cardiovascular morbidity and mortality. The eCS also predicts obstructive CAD, incrementally to age and clinical variables, although for this purpose CACS remains the most accurate score.
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Affiliation(s)
- Nicola Gaibazzi
- Cardiology Department, Parma University Hospital, 43123 Parma, Italy.
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50
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Gaibazzi N, Sicari R, Agricola E, Cioffi G, Mazzone C, Albertini L, Faden G, Molinaro S, Regazzoli D, Di Lenarda A, Faggiano P. Cardiac calcification at transthoracic echocardiography predicts stress echo results: a multicentre study. Int J Cardiol 2014; 174:393-5. [PMID: 24768381 DOI: 10.1016/j.ijcard.2014.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 04/01/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Nicola Gaibazzi
- Cardiology Department, Parma University Hospital, Parma, Italy.
| | - Rosa Sicari
- CNR Institute of Clinical Physiology, Pisa, Italy
| | | | - Giovanni Cioffi
- Echocardiography Laboratory, Villa Bianca Hospital, Trento, Italy
| | | | - Lisa Albertini
- Cardiology Department, Parma University Hospital, Parma, Italy
| | | | | | - Damiano Regazzoli
- Division of noninvasive Cardiology, IRCCS Ospedale San Raffaele, Milano
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