title: Arterial wave reflection and aortic valve calcification in an elderly community-based cohort.
abstract: BACKGROUND
  Aortic valve calcification (AVC) without stenosis is common in the elderly, is associated with cardiovascular morbidity and mortality, and may progress to aortic valve stenosis. Arterial stiffness and pulse-wave reflection are important components of proximal aortic hemodynamics, but their relationship with AVC is not established.
  
  
  METHODS
  To investigate the relationship of arterial wave reflection and stiffness with AVC, pulse wave analysis and AVC evaluation by echocardiography were performed in 867 participants from the Cardiovascular Abnormalities and Brain Lesions study. Participants were divided into four categories on the basis of the severity and extent of AVC: (1) none or mild focal AVC, (2) mild diffuse AVC, (3) moderate to severe focal AVC, and (4) moderate to severe diffuse AVC. Central blood pressures and pulse pressure, total arterial compliance, augmentation index, and time to wave reflection were assessed using applanation tonometry.
  
  
  RESULTS
  Indicators of arterial stiffness and wave reflection were significantly associated with AVC severity, except for central systolic and diastolic pressures and time to reflection. After adjustment for pertinent covariates (age, sex, race/ethnicity, and estimated glomerular filtration rate), only augmentation pressure (P = .02) and augmentation index (P = .002) were associated with the severity of AVC. Multivariate logistic regression analysis revealed that augmentation pressure (odds ratio per mm Hg, 1.14; 95% confidence interval, 1.02-1.27; P = .02) and augmentation index (odds ratio per percentage point, 1.07; 95% confidence interval, 1.01-1.13; P = .02) were associated with an increased risk for moderate to severe diffuse AVC, even when central blood pressure value was included in the same model.
  
  
  CONCLUSIONS
  Arterial wave reflection is associated with AVC severity, independent of blood pressure values. Increased contribution of wave reflection to central blood pressure could be involved in the process leading to AVC.
authors.affiliation: Department of Medicine, Columbia University, New York, New York.
authors.forename: Fusako
authors.initials: F
authors.lastname: Sera
authors.affiliation: Department of Medicine, Columbia University, New York, New York.
authors.forename: Cesare
authors.initials: C
authors.lastname: Russo
authors.affiliation: Department of Medicine, Columbia University, New York, New York.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Iwata
authors.affiliation: Department of Biostatistics, Columbia University, New York, New York.
authors.forename: Zhezhen
authors.initials: Z
authors.lastname: Jin
authors.affiliation: Departments of Neurology and Public Health Sciences, University of Miami, Miami, Florida.
authors.forename: Tatjana
authors.initials: T
authors.lastname: Rundek
authors.affiliation: Departments of Neurology and Epidemiology, Columbia University, New York, New York.
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
authors.affiliation: Department of Medicine, Columbia University, New York, New York.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Homma
authors.affiliation: Departments of Neurology and Public Health Sciences, University of Miami, Miami, Florida; Department of Human Genetics, University of Miami, Miami, Florida.
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.affiliation: Department of Medicine, Columbia University, New York, New York. Electronic address: md42@cumc.columbia.edu.
authors.forename: Marco R
authors.initials: MR
authors.lastname: Di Tullio
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000209:etiology; D001783:Blood Flow Velocity; D001794:Blood Pressure; D002114:Calcinosis / Q000150:complications / Q000000981:diagnostic imaging*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D063177:Pulse Wave Analysis / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D059289:Vascular Stiffness
keywords: Aortic valve calcification; Arterial stiffness; Blood pressure; Wave reflection