Aortic valve calcium on spiral computed tomography (dual slice mode) is associated with advanced coronary calcium in hypertensive patients.
BACKGROUND
Aortic valve calcium (AVC) is common in the elderly and is associated with an increase risk of death from cardiovascular causes and of myocardial infarction. The goal of the present study was to determine whether an association exists between the presence of AVC and coronary calcium (CC) in high-risk hypertensive patients as detected by spiral computed tomography (dual slice mode) (DHCT).


METHODS
Three hundred and seventy-six hypertensive patients participating in the International Nifedipine Gastrointestinal Therapeutic System (GITS) Study of Intervention as a Goal in Hypertension Treatment (INSIGHT) in our region were included (197 men and 179 women, age range 55-79 years). All underwent DHCT of the heart for CC scoring using previously published methods. A positive test for the presence of CC was defined as the presence of at least one lesion with an area of 0.5 mm and DHCT density above 90 Hounsfield units (total CC score >0). CC was considered advanced when total calcium score was >300. AVC was defined by DHCT as any detected calcified deposit in the region of the aortic valve. Patients without AVC served as the control group.


RESULTS
AVC was documented in 70 patients (36 men, 34 women; mean age 66 +/- 5 years, range 57-79 years). The age- and sex-matched non-AVC group (control group) included 306 patients (161 men, 145 women; mean age 67 +/- 5 years, range 55-75 years). There were no intergroup differences in risk factors for atherosclerosis. Significant differences were found between AVC and the control groups for mean CC score (388 +/- 754 compared with 147 +/- 307, P< 0.001) and between the presence of advanced CC and the control group (27 compared with 15%, P= 0.02). Significant differences were also found for the presence of three-vessel calcification (36 compared with 21%, P= 0.01) and the number of vessels involved (1.8 +/- 1.1 compared with 1.4 +/- 1.1, P= 0.01). Stepwise logistic regression found age [odds ratio (OR) 1.08, 95% confidence intervals (CI) 1.03-1.15), gender (OR 0.45, 95% CI 0.25-0.82) and AVC (OR 2.07, 95% CI 1.06-4.02)] to be the only variables that predict advanced CC.


CONCLUSIONS
Our study demonstrated a significant association between the presence of AVC and advanced CC on spiral computed tomography. These results strengthen earlier findings of a high association between AVC and increased risk of death from cardiovascular causes.
Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel-Hashomer and Sackler Faculty of Medicine, Tel-Aviv University, Israel. aldery@yahoo.com
Yehuda
Y
Adler
Joseph
J
Shemesh
Alexander
A
Tenenbaum
Boaz
B
Hovav
Enrique Z
EZ
Fisman
Michael
M
Motro
D000367:Age Factors; D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000378:metabolism; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000378:metabolism; D002118:Calcium / Q000032:analysis*; D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D036542:Tomography, Spiral Computed
D002118:Calcium