Aortic valve calcification in hypertensive patients: prevalence, risk factors and association with transvalvular flow velocity.
BACKGROUND
The important role of the "nonobstructive" aortic valve calcification (AVC) in cardiovascular morbidity and mortality has recently been emphasized. The present work had two goals: (1) to analyze the prevalence and factors determining the extent of AVC in hypertensive patients; (2) to investigate a possible association between the extent of AVC and flow velocity across the aortic valve.


METHODS
This was a prospective study performed in a university hospital. The sample included 263 consecutive patients (139 men and 124 women), mean age 65+/-6, who underwent echo-Doppler. The upper quartile of peak flow velocity across the aortic valve (>130 mm/s in our population) was defined as augmented flow velocity.


RESULTS
There were 31 (12%) patients in the advanced AVC group and 122 (46%) without any calcified deposits (the no AVC group). The remaining 110 (42%), who did not meet criteria for advanced AVC, comprised the trivial AVC group. Peak flow velocity was significantly higher in patients with advanced vs. trivial AVC and no AVC groups: 135+/-45, 116+/-23 and 113+/-23 cm/s, respectively; p=0.0002. Prevalence of augmented transvalvular aortic flow was significantly higher (p=0.01) among patients with advanced AVC (41.9%) vs. trivial (20.9%) and no AVC (20.5%). Multivariate analyses identified age as the only independent variable associated with advanced AVC [OR 1.6 (CI 1.2-2.3), 5 years increment]. Advanced AVC and female gender were identified as independent variables for augmented transvalvular aortic flow with OR 2.9 (CI 1.3-6.4) and 2.5 (CI 1.4-4.6), respectively.


CONCLUSIONS
Prevalence of AVC among hypertensive patients is high and clearly age-related. Female gender and advanced (but not trivial) AVC are associated with augmented aortic transvalvular peak flow. Our results stress the role of protruding calcium deposits in augmentation of rest flow velocity across the aortic valve regardless of visible restriction of leaflet opening.
Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel. altenen@yahoo.com
Alexander
A
Tenenbaum
Enrique Z
EZ
Fisman
Ehud
E
Schwammenthal
Yehuda
Y
Adler
Joseph
J
Shemesh
Yaniv
Y
Sherer
Michael
M
Motro
D000367:Age Factors; D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000378:metabolism; D001783:Blood Flow Velocity; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000378:metabolism; D002118:Calcium / Q000032:analysis; D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000503:physiopathology; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012737:Sex Factors
D002118:Calcium