title: Prognostic value of echocardiographic calcium score in patients with a clinical indication for stress echocardiography.
abstract: OBJECTIVE
  The value of the echocardiographic calcium score (eCS) was evaluated to predict cardiac events in a multicenter cohort of subjects without known coronary disease, who underwent stress echocardiography (SE) for suspected coronary artery disease (CAD).
  
  
  BACKGROUND
  Several studies have established that aortic valve sclerosis and/or calcification and mitral calcification, as detected by echocardiography, predict cardiovascular morbidity and mortality. The use of a semiquantitative total cardiac calcium score (eCS) to assess aortic and mitral valves, papillary muscles, and the ascending aorta has never been tested in multicenter studies; the inherent subjectivity and clinical applicability of such a parameter remains a concern.
  
  
  METHODS
  We identified 1,303 patients from 5 Italian institutions and 1 U.S. institution, who had no known CAD and who underwent clinically-indicated pharmacological or exercise SE. They were followed up for myocardial infarction (MI) and all-cause death. eCS was assessed from archived images, and its discrimination and reclassification prognostic potential was determined.
  
  
  RESULTS
  Fifty-eight patients met the combined endpoint of all-cause death (n = 37; 2.8%) or MI (n = 21; 1.6%) during a median follow-up of 808 days. Age, diabetes mellitus, eCS >0, and ischemic SE were multivariate predictors of hard events. Kaplan-Meier curves demonstrated that patients with ischemic SE or eCS >0 had worse outcomes. When both variables were abnormal, the prognosis was worse (p < 0.001). The multivariate model demonstrated that both eCS and ischemic SE independently contributed to risk prediction more than clinical variables. Both wall motion during SE and eCS were able to significantly reclassify the risk of events, but only stress wall motion demonstrated an incremental discrimination value.
  
  
  CONCLUSIONS
  eCS demonstrated significant prognostic value in predicting hard cardiac events in a multicenter population of patients who required noninvasive evaluation. Its value was independent from clinical assessment and wall motion during SE, although it did not show incremental value over these factors for discrimination of patients with and without events.
authors: Department of Cardiology, Parma University Hospital, Parma, Italy. Electronic address: ngaibazzi@gmail.com.
authors: Nicola
authors: N
authors: Gaibazzi
authors: Section of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
authors: Thomas R
authors: TR
authors: Porter
authors: Division of Non-Invasive Cardiology, San Raffaele Hospital, Milan, Italy.
authors: Eustachio
authors: E
authors: Agricola
authors: Echocardiography Laboratory, Villa Bianca Hospital, Trento, Italy.
authors: Giovanni
authors: G
authors: Cioffi
authors: Cardiovascular Center, Azienda Sanitaria di Trieste, Trieste, Italy.
authors: Carmine
authors: C
authors: Mazzone
authors: Scuola Superiore Sant'Anna, Pisa, Italy.
authors: Valentina
authors: V
authors: Lorenzoni
authors: Department of Cardiology, Parma University Hospital, Parma, Italy.
authors: Lisa
authors: L
authors: Albertini
authors: Department of Cardiology, University of Brescia, Brescia, Italy.
authors: Giacomo
authors: G
authors: Faden
authors: Section of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
authors: Mohammed
authors: M
authors: Chamsi Pasha
authors: Section of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
authors: Bipul
authors: B
authors: Biabhav
authors: Division of Non-Invasive Cardiology, San Raffaele Hospital, Milan, Italy.
authors: Damiano
authors: D
authors: Regazzoli
authors: Cardiovascular Center, Azienda Sanitaria di Trieste, Trieste, Italy.
authors: Andrea
authors: A
authors: Di Lenarda
authors: Department of Cardiology, University of Brescia, Brescia, Italy.
authors: Pompilio
authors: P
authors: Faggiano
mesh_terms: D000368:Aged; D002423:Cause of Death; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States; D061205:Vascular Calcification / Q000000981:diagnostic imaging* / Q000401:mortality
keywords: calcium score; cardiac events; echocardiography; prognosis; stress echocardiography