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Aortic Root Calcification Score as an Independent Factor for Predicting Major Adverse Cardiac Events in Familial

Hirofumi Okada¹, Hayato Tada¹, Kenshi Hayashi¹

¹Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine.

Journal of Atherosclerosis and Thrombosis

|January 12, 2018

Insights

Aortic root calcification (ARC) assessed by coronary computed tomography angiography (CCTA) predicts cardiovascular events in familial hypercholesterolemia (FH) patients. ARC onset in FH patients occurs around age 17-20.

Area of Science:

Cardiovascular Imaging
Cardiology
Genetics

Background:

Familial hypercholesterolemia (FH) is a genetic disorder leading to high LDL-C levels and premature cardiovascular disease.
Aortic root calcification (ARC) is an emerging marker for cardiovascular risk.
Predictive value of ARC in FH patients remains under investigation.

Purpose of the Study:

To assess if aortic root calcification (ARC) predicts future cardiovascular events in patients with familial hypercholesterolemia (FH).
To estimate the onset and progression of ARC in FH patients.

Main Methods:

Retrospective evaluation of 113 Japanese patients with heterozygous FH undergoing CCTA.
ARC assessed by Agatston score; major adverse cardiac events (MACE) defined and tracked.
Multivariate logistic regression used to analyze MACE prediction by ARC.

Main Results:

During a median follow-up of 1635 days, 19 MACE occurred.
ARC was a significant independent predictor of MACE (OR=1.48, p<0.001).
Regression models established ARC progression equations for males and females.

Conclusions:

Aortic root calcification (ARC) is significantly associated with future MACE in Japanese patients with heterozygous FH.
ARC may begin developing around ages 17.4 (males) and 19.7 (females) in FH patients.

Read full analysis

Abstract

Aim:

The aims of this study were: 1) to determine whether the accumulation of aortic root calcification (ARC) assessed using coronary computed tomography angiography (CCTA) can predict future cardiovascular events, and 2) to estimate the onset and progression of ARC in patients with familial hypercholesterolemia (FH).

Methods:

One hundred thirteen consecutive Japanese patients with heterozygous FH (male=54, mean age=52.1±15.6 years, mean LDL-C=299.0±94.6 mg/dL), without known coronary artery disease, who underwent 64-detector row CCTA were retrospectively evaluated. ARC was defined as the presence of calcium at the aortic root. The extent of ARC was expressed in Agatston units as the ARC-score. Major adverse cardiac events (MACE) were defined as either cardiac death, ST elevated myocardial infarction (STEMI), non-ST elevated myocardial infarction (NSTEMI), unstable angina pectoris (UAP), planned percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or stroke. The periods to MACE were estimated using multivariate logistic regression analysis.

Results:

During the follow-up period (median 1635 days), 19 instances of MACE occurred. Multivariate logistic regression analysis revealed that ARC was a significant independent predictor of MACE (OR=1.48; 95% CI 1.11-1.87, p＜0.001, respectively). The regression equations were Y=0.09X- 1.59 (R²=0.34, p＜0.001) in males and Y=0.08X-1.60 (R²=0.13, p＜0. 05) in females.

Conclusions:

ARC was significantly associated with future MACE in Japanese patients with heterozygous FH. ARC may start to develop, on average, at 17.4 and 19.7 years of age in males and females, respectively, with heterozygous FH.

Keywords:

Aortic valve calcification Coronary computed tomography angiography Familial hypercholesterolemia

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