title: Nonobstructive aortic valve calcification: a window to significant coronary artery disease.
abstract: BACKGROUND
  Aortic valve calcification without obstruction (AVC) is common in the elderly and is associated with increased cardiovascular mortality and morbidity. We hypothesized that AVC detected by transthoracic echocardiography (TTE) is a marker for significant coronary artery disease in patients undergoing coronary angiography.
  
  
  METHODS
  The study group included 388 patients with AVC (259 males, 129 females; mean age 72.2+/-9 years) who underwent coronary angiography for various indications. Data were compared with 320, age- and sex-matched patients without AVC who underwent coronary angiography for the same indications. AVC was detected in TTE as focal areas of increased echogenicity and thickening of the aortic-valve leaflets without restriction in motion. Significant obstructive coronary artery disease was defined as either a > or = 70% reduction of the internal diameter of the left anterior descending, right coronary, or left circumflex artery distribution or a > or = 50% reduction of the internal diameter of the left main coronary artery. Risk factors for atherosclerosis including hypertension, smoking, hypercholesterolemia and diabetes were also investigated.
  
  
  RESULTS
  Compared with control group, the AVC group had a higher prevalence of significant coronary artery disease (90 vs. 85%, P=0.019), and a trend for lower frequency of coronary arteries without obstruction (6 vs. 9%, P=0.l1); a trend was also noted for 3-vessel disease (38 vs. 33%, P=0.14). Multivariate analysis identified age (P=0.000l), sex (P=0.000l), hypercholesterolemia (P=0.005) and AVC (P=0.02) as independent predictors for significant coronary artery disease.
  
  
  CONCLUSIONS
  There is a significant association between AVC and significant coronary artery disease in patients undergoing coronary angiography. Thus AVC can serve as a window to atherosclerosis of the coronary arteries. These results reinforce a previous observation regarding association between AVC and increased risk of cardiovascular morbidity.
authors.affiliation: The Scheingarten Echocardiography Unit, Department of Cardiology, Rabin Medical Center, Beilinson Campus, 49100 Petah Tiqua, Israel.
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Adler
authors.forename: Mordehay
authors.initials: M
authors.lastname: Vaturi
authors.forename: Itzhak
authors.initials: I
authors.lastname: Herz
authors.forename: Zaza
authors.initials: Z
authors.lastname: Iakobishvili
authors.forename: Jacob
authors.initials: J
authors.lastname: Toaf
authors.forename: Noam
authors.initials: N
authors.lastname: Fink
authors.forename: Alexander
authors.initials: A
authors.lastname: Battler
authors.forename: Alex
authors.initials: A
authors.lastname: Sagie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology*; D002114:Calcinosis / Q000150:complications* / Q000473:pathology; D003324:Coronary Artery Disease / Q000150:complications* / Q000473:pathology; D004452:Echocardiography; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged