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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Non-coronary cardiac calcifications and outcomes in patients with heart failure
Guy Topaz1, Eyal Yehezkel2, Sydney Benchetrit3
1Department of Internal Medicine C, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
Cardiac calcifications in heart failure (HF) patients are linked to increased mortality and hospitalizations. Echocardiography can help identify these calcifications for better risk stratification in HF management.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Medical Imaging
Background:
- Cardiac calcifications, a manifestation of atherosclerosis, are linked to adverse cardiovascular outcomes.
- The prognostic significance of cardiac calcifications in heart failure (HF) patients, particularly when assessed via echocardiography, remains unclear.
Purpose of the Study:
- To investigate the association between cardiac calcifications and mortality and hospital admissions in patients with heart failure.
- To determine the clinical significance of cardiac calcifications detected by echocardiography in ambulatory HF patients.
Main Methods:
- Retrospective review of medical records for 814 ambulatory HF patients (2011-2018).
- Evaluation of calcifications in the aortic valve, aortic root, or mitral valve, excluding patients with moderate to severe valve dysfunction.
- Primary endpoint: composite of long-term all-cause mortality and HF hospitalizations; Secondary endpoints: all-cause mortality and recurrent HF hospitalizations.
Main Results:
- 57% of patients exhibited at least one site of cardiac calcification.
- Patients with cardiac calcifications had significantly higher adjusted odds ratios for the composite endpoint (OR=1.68), all-cause death (OR=1.61), and recurrent HF hospitalizations (OR=1.50) compared to those without calcifications.
- These associations remained statistically significant (p < 0.01).
Conclusions:
- Cardiac calcifications are independently associated with an increased risk of death and HF hospitalizations in ambulatory HF patients.
- Routine echocardiographic assessment of cardiac calcifications may enhance risk stratification for patients with heart failure.
- This finding underscores the importance of evaluating cardiac calcifications in HF patient management.
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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