Echocardiographic calcification score in patients with low/intermediate cardiovascular risk
Kristof Hirschberg1, Manuel Reinhart2, Derliz Mereles2
1Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. Kristof.Hirschberg@med.uni-heidelberg.de.
Insights
An echocardiographic calcification score (echo-CCS) effectively predicts cardiac events and mortality in patients with low/intermediate cardiovascular risk. This radiation-free method shows strong correlation with CT-calcium scoring, offering a potential alternative for cardiovascular risk assessment.
Area of Science:
- Cardiology
- Medical Imaging
- Risk Assessment
Background:
- Cardiac calcification, particularly of the aortic valve and mitral annulus, is linked to cardiovascular risk factors, morbidity, and mortality.
- Echocardiography can assess cardiac calcification, but few structured scoring systems with limited prognostic data exist.
- Existing methods often lack comprehensive prognostic data for cardiovascular risk stratification.
Purpose of the Study:
- To evaluate an echocardiographic calcification score (echo-CCS) for its prognostic value in patients with low to intermediate cardiovascular risk.
- To assess the correlation of echo-CCS with computed tomography (CT) calcium score and coronary artery stenosis.
- To determine the association of echo-CCS with cardiac events and all-cause mortality.
Main Methods:
- Retrospective review of echocardiography studies from 151 patients (median age 64) to assign an echo-CCS (0-5).
- Assessment of echo-CCS correlation with CT calcium score, coronary stenosis, and European Society of Cardiology (ESC) SCORE.
- Follow-up data (median 6.2 years) collected for 149 patients to analyze associations with cardiac events and mortality using logistic regression and Kaplan-Meier analysis.
Main Results:
- Echo-CCS showed a strong correlation with the Agatston score (ρ=0.73, p<0.001) and ESC SCORE (ρ=0.5, p<0.001).
- Echo-CCS was a significant predictor for cardiac events (OR=5.1), coronary intervention (OR=2.8), cardiac hospitalizations (OR=2.0), all-cause mortality (OR=2.6), and significant coronary artery disease (CAD) (OR=3.2).
- All associations were statistically significant (p<0.05).
Conclusions:
- An easily obtainable, radiation-free echocardiographic calcification score (echo-CCS) is prevalent in patients with low/intermediate cardiovascular risk.
- The strong association of echo-CCS with CT-calcium scoring suggests its potential as an alternative method for cardiovascular risk assessment.
- Echo-CCS provides valuable prognostic information, aiding in risk stratification for cardiac events and mortality.
Purpose:
Calcification of aortic valve and mitral annulus is associated with cardiovascular risk factors, morbidity and mortality. Assessment of cardiac calcification with echocardiography is feasible, however, only few structured scoring systems have been established so far with limited prognostic data. This study aimed to evaluate an echocardiographic calcification score (echo-CCS) in patients with low/intermediate cardiovascular risk.
Methods:
Digitally stored echocardiography studies of 151 patients (median age 64, 49.7% male) from February 2008 to December 2009 were retrospectively reviewed for calcifications of the aortic valve, aortic root, mitral annulus, papillary muscles and ventricular septum. A calcification score ranging from 0 to 5 was assigned to every patient and its relation to computed tomography calcium score, coronary stenosis and ESC SCORE was assessed. Follow-up data were collected from 149 patients (98.7%) with a median of 6.2 years. Logistic regression and Kaplan-Meier analysis were performed to assess the association of the echo-CCS with significant coronary artery disease (≥ 50% stenosis) and risk for cardiac events and all-cause mortality.
Results:
An association of the echo-CCS with the ESC SCORE (ρ = 0.5; p < 0.001) and a good correlation of the echo-CCS with the Agatston score (ρ = 0.73; p < 0.001) can be observed. Univariate regressions revealed that echo-CCS is a significant predictor for cardiac events [OR = 5.1 (CI: 1.7-15.0); p = 0.003], coronary intervention [OR = 2.8 (CI: 1.3-5.7); p = 0.006], hospitalisation for cardiac symptoms [OR = 2.0 (CI: 1.2-3.4); p = 0.007], all-cause mortality [OR = 2.6 (CI: 1.3-5.5); p = 0.01] and significant CAD [OR = 3.2 (CI: 1.9-5.4); p < 0.001].
Conclusions:
We demonstrated the prevalence of an easily obtainable, radiation-free calcification score in patients with low/intermediate cardiovascular risk. The strong association with CT-calcium scoring may evoke its potential as an alternative method in CV risk assessment.
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