title: Association between aortic valve calcification and myocardial ischemia, especially in asymptomatic patients.
abstract: Aortic valve calcification (AVC) is recognized as a manifestation of systemic arteriosclerosis. However, it is unclear whether AVC is associated with myocardial ischemia. Stress myocardial perfusion SPECT (MPS) is widely used for the diagnosis of myocardial ischemia. However, routine MPS is not recommended, particularly in asymptomatic patients. Accordingly, we investigated the hypothesis that the presence of AVC is strongly associated with inducible myocardial ischemia, even among asymptomatic patients.
  
  
  METHODS
  We investigated 669 consecutive patients who underwent both adenosine stress (201)Tl MPS and echocardiography. We evaluated the extent and severity of myocardial ischemia by the summed difference score (SDS). We defined the presence of myocardial ischemia as SDS ≥ 3 and moderate to severe ischemia as SDS ≥ 8. We classified the severity of AVC according to the number of affected aortic leaflets. We also compared the mean SDS and the prevalence of SDS ≥ 3 and SDS ≥ 8 among patients stratified by the severity of AVC.
  
  
  RESULTS
  The presence of AVC was significantly associated with myocardial ischemia (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.10-2.23; P = 0.013) and moderate to severe ischemia (OR, 2.16; 95% CI, 1.26-3.80; P = 0.0061). In 311 asymptomatic patients, AVC was strongly associated with moderate to severe ischemia (OR, 4.31; 95% CI, 1.67-12.8; P = 0.0043). However, the SDS value and the prevalence of SDS ≥ 3 and SDS ≥ 8 did not increase with increasing number of affected aortic leaflets.
  
  
  CONCLUSIONS
  The presence of AVC may be associated with the presence of myocardial ischemia, particularly in asymptomatic patients. However, we found no association between the extent of AVC and inducible myocardial ischemia. The presence of AVC may be a useful anatomic marker to help identify patients at high risk of myocardial ischemia, particularly asymptomatic patients.
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Yamazato
authors.forename: Hideya
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Futoshi
authors.initials: F
authors.lastname: Tadehara
authors.forename: Hiroki
authors.initials: H
authors.lastname: Teragawa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kurisu
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Dohi
authors.forename: Ken
authors.initials: K
authors.lastname: Ishibashi
authors.forename: Eiji
authors.initials: E
authors.lastname: Kunita
authors.forename: Hiroto
authors.initials: H
authors.lastname: Utsunomiya
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Oka
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Kihara
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging; D058070:Asymptomatic Diseases; D002114:Calcinosis / Q000150:complications*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D017202:Myocardial Ischemia / Q000150:complications* / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon