title: Association between cardiac valvular calcification and myocardial ischemia in asymptomatic high-risk patients with end-stage renal disease.
abstract: OBJECTIVE
  Valvular calcification is associated with significant morbidity and mortality in patients with end stage renal disease (ESRD). This study examined the hypothesis that valvular calcification is a marker of myocardial ischemia in asymptomatic high-risk patients with ESRD.
  
  
  METHODS
  Echocardiography and myocardial perfusion single-photon emission computed tomography were performed in 285 asymptomatic high-risk patients with ESRD at initiation of dialysis. We evaluated the extent and severity of myocardial ischemia by the summed difference score (SDS) and defined the presence of myocardial ischemia as SDS ≥ 3 and moderate to severe ischemia as SDS ≥ 8. The presence of cardiac valvular calcification was assessed by echocardiography and defined as aortic valve calcification or mitral valve calcification.
  
  
  RESULTS
  Eighty-five (29.9%) patients had echocardiographic evidence of cardiac valvular calcification. The presence of myocardial ischemia was significantly associated with aortic valve calcification (odds ratio [OR] = 3.19; 95% confidence interval [CI] = 1.76-5.78; p < 0.001), mitral valve calcification (OR = 3.31; 95% CI = 1.74-6.28; p < 0.001), and cardiac valvular calcification (OR = 3.18; 95% CI = 1.79-5.65; p < 0.001). The presence of moderate to severe myocardial ischemia (SDS ≥ 8) was independently associated with cardiac valvular calcification (OR = 2.86; 95% CI = 1.12-7.27; p = 0.028).
  
  
  CONCLUSIONS
  Valvular calcification was significantly associated with the presence of inducible myocardial ischemia in asymptomatic patients with ESRD, and may be a potential marker of patients at high-risk for the presence of silent myocardial ischemia.
authors.affiliation: Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea.
authors.forename: Myung Jin
authors.initials: MJ
authors.lastname: Choi
authors.forename: Jwa-Kyung
authors.initials: JK
authors.lastname: Kim
authors.forename: Sung Gyun
authors.initials: SG
authors.lastname: Kim
authors.forename: Sung Eun
authors.initials: SE
authors.lastname: Kim
authors.forename: Soo Jin
authors.initials: SJ
authors.lastname: Kim
authors.forename: Hyung Jik
authors.initials: HJ
authors.lastname: Kim
authors.forename: Young Rim
authors.initials: YR
authors.lastname: Song
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging; D058070:Asymptomatic Diseases / Q000453:epidemiology; D000082882:Bicuspid Aortic Valve Disease; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D004452:Echocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006435:Renal Dialysis; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D015899:Tomography, Emission-Computed, Single-Photon
keywords: Echocardiography; End-stage renal disease; Myocardial perfusion imaging; Silent myocardial ischemia; Valvular calcification