title: Prognostic value of aortic and mitral valve calcium detected by contrast cardiac computed tomography angiography in patients with suspicion of coronary artery disease.
abstract: Aortic valve calcium (VC) detected on noncontrast cardiac computed tomography angiography (CCTA) is known to be associated with all-cause mortality in asymptomatic and primary prevention population. However, the clinical significance of aortic and mitral VC remains unknown in symptomatic patients with suspected coronary artery disease (CAD). The aim of the present study was to assess whether aortic and mitral VC is independently associated with cardiac events and all-cause mortality in symptomatic patients with suspected CAD. A total of 369 symptomatic patients (mean age 55 ± 11 years, 60% men) who were referred for CCTA because of suspected CAD were included in the study. Aortic and mitral VC was detected and quantified by volume on contrast CCTA. Median follow-up for events (coronary events and all-cause mortality) was 2.8 (interquartile range 1.6 to 4.0) with a maximum of 5.5 years. A total of 39 patients (11%) had VC. Increased age, hypertension, and increased Agatston coronary artery calcium score were associated with VC. During the follow-up, patients with VC had higher risk for a coronary event (38.8% vs 11%, log-rank p <0.001) and worse survival rate (92.3% vs 99.1%, log-rank p = 0.002) compared with those without VC. Volume of VC was independently associated with outcome after adjusting for clinical variables (hazard ratio 1.88, p <0.001), Agatston coronary artery calcium score (hazard ratio 1.47, p = 0.03), and significant CAD (hazard ratio 1.81, p = 0.001). In conclusion, aortic and mitral VC volume quantified on contrast CCTA was independently associated with coronary events and all-cause mortality in patients with suspected CAD.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, American Hellenic Educational Progressive Association University Hospital, Thessaloniki, Greece.
authors.forename: Vasileios
authors.initials: V
authors.lastname: Kamperidis
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; The Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands.
authors.forename: Michiel A
authors.initials: MA
authors.lastname: de Graaf
authors.affiliation: Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Alexander
authors.initials: A
authors.lastname: Broersen
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Wehab
authors.initials: W
authors.lastname: Ahmed
authors.affiliation: Department of Cardiology, American Hellenic Educational Progressive Association University Hospital, Thessaloniki, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Sianos
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
authors.affiliation: Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Jouke
authors.initials: J
authors.lastname: Dijkstra
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: a.j.h.a.scholte@lumc.nl.
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Scholte
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality*; D023921:Coronary Stenosis / Q000453:epidemiology; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging / Q000453:epidemiology; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000473:pathology; D011379:Prognosis; D012307:Risk Factors