title: Combined presence of aortic valve calcification and mitral annular calcification as a marker of the extent and vulnerable characteristics of coronary artery plaque assessed by 64-multidetector computed tomography.
abstract: OBJECTIVE
  We examined the association of aortic valve calcification (AVC) and mitral annular calcification (MAC) to coronary atherosclerosis using 64-multidetector computed tomography (MDCT).
  
  
  BACKGROUND
  Valvular calcification is considered a manifestation of atherosclerosis. The impact of multiple heart valve calcium deposits on the distribution and characteristics of coronary plaque is unknown.
  
  
  METHODS
  We evaluated 322 patients referred for 64-MDCT, and assessed valvular calcification and the extent of calcified (CAP), mixed (MCAP), and noncalcified coronary atherosclerotic plaque (NCAP) in accordance with the 17-coronary segments model. We assessed the vulnerable characteristics of coronary plaque with positive remodeling, low-density plaque (CT density ≤38 Hounsfield units), and the presence of adjacent spotty calcification.
  
  
  RESULTS
  In 49 patients with both AVC and MAC, the segment numbers of CAP and MCAP were larger than in those with a lack of valvular calcification and an isolated AVC (p<0.001 for both). Multivariate analyses revealed that a combined presence of AVC and MAC was independently associated with the presence (odds ratio [OR] 9.36, 95% confidence interval [95%CI] 1.55-56.53, p=0.015) and extent (β-estimate 1.86, p<0.001) of overall coronary plaque. When stratified by plaque composition, it was associated with the extent of CAP (β-estimate 1.77, p<0.001) and MCAP (β-estimate 1.04, p<0.001), but not with NCAP. Moreover, it was also related to the presence of coronary plaque with all three vulnerable characteristics (OR 4.87, 95%CI 1.85-12.83, p=0.001).
  
  
  CONCLUSIONS
  The combined presence of AVC and MAC is highly associated with the presence, extent, and vulnerable characteristics of coronary plaque identified by 64-MDCT.
authors.affiliation: Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Utsunomiya
authors.forename: Hideya
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Eiji
authors.initials: E
authors.lastname: Kunita
authors.forename: Toshiro
authors.initials: T
authors.lastname: Kitagawa
authors.forename: Norihiko
authors.initials: N
authors.lastname: Ohashi
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Oka
authors.forename: Ryo
authors.initials: R
authors.lastname: Yamazato
authors.forename: Jun
authors.initials: J
authors.lastname: Horiguchi
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Kihara
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000378:metabolism*; D001024:Aortic Valve Stenosis / Q000473:pathology*; D050197:Atherosclerosis / Q000473:pathology; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000473:pathology*; D058226:Plaque, Atherosclerotic / Q000473:pathology*; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods