Association between heart calcification assessed by echocardiography and future cardiovascular disease mortality and
Hiroto Utsunomiya1, Hideya Yamamoto1, Yoji Urabe1
1Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
Insights
Echocardiography can assess heart calcification, including aortic valve calcification (AVC), mitral annular calcification (MAC), and aortic root calcification (ARC). A higher total heart calcification (THC) score independently predicts increased cardiovascular disease mortality and morbidity in high-risk patients.
Area of Science:
- Cardiology
- Medical Imaging
- Preventive Medicine
Background:
- Echocardiography identifies heart calcifications like AVC, MAC, and ARC.
- The prognostic significance of these echocardiographic findings for future cardiovascular disease (CVD) risk is not fully understood.
Purpose of the Study:
- To investigate the association between echocardiographic heart calcification and subsequent CVD mortality and morbidity.
- To determine if a summed Total Heart Calcification (THC) score improves CVD risk prediction.
Main Methods:
- Analysis of 943 patients with suspected coronary heart disease, followed for a mean of 2.9 years.
- Calculation of a Total Heart Calcification (THC) score by summing AVC, MAC, and ARC.
- Assessment of CVD mortality and morbidity (non-fatal MI, heart failure, stroke, vascular surgery).
Main Results:
- A graded increase in CVD mortality and morbidity was observed with higher THC scores.
- Cox regression showed significantly elevated hazard ratios for CVD events with increasing THC scores (THC-1, THC-2, THC-3).
- Adding THC score to CVD risk factor models significantly improved predictive C-statistics for CVD mortality and morbidity.
Conclusions:
- The Total Heart Calcification (THC) score, derived from echocardiography, offers independent prognostic value.
- THC score incrementally enhances risk prediction for cardiovascular events in high-risk populations.
Background:
Echocardiography can detect calcium deposits in heart valves and aortic root, but the relationship of echocardiographic heart calcification such as aortic valve calcification (AVC), mitral annular calcification (MAC), and aortic root calcification (ARC) with future cardiovascular disease (CVD) mortality and morbidity is not fully elucidated.
Methods:
We analyzed data from 943 patients with suspected coronary heart disease (mean age, 65.7 years; 36% female). Echocardiographic total heart calcification (THC) score was determined by summing up the AVC, MAC, and ARC variables; THC-0 (N = 397), THC-1 (N = 236), THC-2 (N = 224), and THC-3 (N = 86). Subjects were followed for mean 2.9 years to assess the risk of death from CVD causes. Cardiovascular morbidity was defined as new episodes of non-fatal myocardial infarction, congestive heart failure, stroke, and surgical treatment of vascular disease.
Results:
There were 43 CVD deaths and a total of 160 CVD events. Kaplan-Meier curves showed a graded CVD mortality and morbidity across increasing THC score values. With full adjustment, Cox regression hazard ratios (95% confidence intervals) for CVD mortality and morbidity, using no calcification as reference, for THC-1, THC-2, and THC-3 were 2.21 (1.31-3.74), 2.59 (1.53-4.39) and 4.14 (2.30-7.47), respectively. When THC score was added to models with CVD risk factors, C-statistics were significantly larger for CVD mortality (p = 0.048) and for CVD mortality and morbidity (p = 0.004).
Conclusions:
THC score, the sum of the amounts of AVC, MAC, and ARC present as estimated by echocardiography, has an independent and incremental prognostic value in a high-risk population.
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