Can total cardiac calcium predict the coronary calcium score?
BACKGROUND
Mitral annular calcification (MAC) shares the same risk factors as atherosclerosis and is associated with coronary artery disease as well as cardiovascular events. However, sensitivity and positive predictive value are low. We hypothesized that a global echocardiographic calcium score would better predict coronary atherosclerotic burden, as assessed by coronary artery calcium score (CAC), than MAC alone.


METHODS
An echocardiographic score was devised to measure global cardiac calcification in a semi-quantitative manner; this included calcification in the aortic valve and root, the mitral valve and annulus, and the sub-mitral apparatus. This score, and a simplified version, were compared with a similar calcification score by CT scan, as well as the CAC.


RESULTS
There was a good correlation between the two global calcification scores; the echocardiographic score also correlated with CAC. Using CAC >400 as a measure of severe coronary atherosclerosis, an echocardiographic score ≥5 had a positive predictive value of 60%. Importantly, the simplified score performed equally well (≥3 had a positive predictive value of 62%).


CONCLUSIONS
Global cardiac calcification, assessed by CT scan or echocardiography, correlates with the extent of coronary calcium. A semi-quantitative calcium score can be easily applied during routine echocardiographic interpretation and can alert the reader to the possibility of severe coronary atherosclerosis.
Pressman
Gregg S
GS
Division of Cardiology, Albert Einstein Medical Center, Philadelphia, PA 19141, USA. PressmanG@einstein.edu
Crudu
Vitalie
V
Parameswaran-Chandrika
Anoop
A
Romero-Corral
Abel
A
Purushottam
Bhaskar
B
Figueredo
Vincent M
VM
D000328:Adult; D000368:Aged; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000453:epidemiology; D002118:Calcium / Q000378:metabolism; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
D002118:Calcium