The association of incidentally detected heart valve calcification with future cardiovascular events.
OBJECTIVE
This study aims to investigate the prognostic value of incidental aortic valve calcification (AVC), mitral valve calcification (MVC) and mitral annular calcification (MAC) for cardiovascular events and non-rheumatic valve disease in particular on routine diagnostic chest CT.


METHODS
The study followed a case-cohort design. 10410 patients undergoing chest CT were followed for a median period of 17 months. Patients referred for cardiovascular disease were excluded. A random sample of 1285 subjects and the subjects who experienced an endpoint were graded for valve calcification by three reviewers. Cox-proportional hazard analysis was performed to evaluate the prognostic value.


RESULTS
515 cardiovascular events were ascertained. Compared with patients with no valve calcification, patients with severe AVC, MVC or MAC had respectively 2.03 (1.48-2.78), 2.08 (1.04-4.19) and 1.53 (1.13-2.08) increased risks of experiencing an event during follow-up. For valve endpoints the hazard ratios were respectively 14.57 (5.19-40.53), 8.78 (2.33-33.13) and 2.43 (1.18-4.98).


CONCLUSIONS
Incidental heart valve calcification, detected on routine chest CT is an independent predictor of future cardiovascular events. The study emphasises how incidental imaging findings can contribute to clinical care. It is a step in the process of composing an evidence-based approach in the reporting of incidental subclinical findings.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, PO Box 85500, 3508 GA Utrecht, Netherlands. m.gondrie@umcutrecht.nl
Martijn J A
MJ
Gondrie
Yolanda
Y
van der Graaf
Peter C
PC
Jacobs
Ay L
AL
Oen
Willem P Th M
WP
Mali
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology*; D002114:Calcinosis / Q000150:complications / Q000175:diagnosis*; D002318:Cardiovascular Diseases / Q000175:diagnosis*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology*; D011379:Prognosis; D013902:Radiography, Thoracic / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods