title: Prognostic value of heart valve calcifications for cardiovascular events in a lung cancer screening population.
abstract: To assess the prognostic value of aortic valve and mitral valve/annulus calcifications for cardiovascular events in heavily smoking men without a history of cardiovascular disease. Heavily smoking men without a cardiovascular disease history who underwent non-contrast-enhanced low-radiation-dose chest CT for lung cancer screening were included. Non-imaging predictors (age, smoking status and pack-years) were collected and imaging-predictors (calcium volume of the coronary arteries, aorta, aortic valve and mitral valve/annulus) were obtained. The outcome was the occurrence of cardiovascular events. Multivariable Cox proportional-hazards regression was used to calculate hazard-ratios (HRs) with 95% confidence interval (CI). Subsequently, concordance-statistics were calculated. In total 3111 individuals were included, of whom 186 (6.0%) developed a cardiovascular event during a follow-up of 2.9 (Q1-Q3, 2.7-3.3) years. If aortic (n = 657) or mitral (n = 85) annulus/valve calcifications were present, cardiovascular event incidence increased to 9.0% (n = 59) or 12.9% (n = 11), respectively. HRs of aortic and mitral valve/annulus calcium volume for cardiovascular events were 1.46 (95% CI, 1.09-1.84) and 2.74 (95% CI, 0.92-4.56) per 500 mm(3). The c-statistic of a basic model including age, pack-years, current smoking status, coronary and aorta calcium volume was 0.68 (95% CI, 0.63-0.72), which did not change after adding heart valve calcium volume. Aortic valve calcifications are predictors of future cardiovascular events. However, there was no added prognostic value beyond age, number of pack-years, current smoking status, coronary and aorta calcium volume for short term cardiovascular events.
authors.affiliation: Department of Radiology, University Medical Center Utrecht, E01.132, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands, m.willemink@umcutrecht.nl.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Willemink
authors.forename: Richard A P
authors.initials: RA
authors.lastname: Takx
authors.forename: Ivana
authors.initials: I
authors.lastname: Išgum
authors.forename: Harry J
authors.initials: HJ
authors.lastname: de Koning
authors.forename: Matthijs
authors.initials: M
authors.lastname: Oudkerk
authors.forename: Willem P Th M
authors.initials: WP
authors.lastname: Mali
authors.forename: Ricardo P J
authors.initials: RP
authors.lastname: Budde
authors.forename: Tim
authors.initials: T
authors.lastname: Leiner
authors.forename: Rozemarijn
authors.initials: R
authors.lastname: Vliegenthart
authors.forename: Pim A
authors.initials: PA
authors.lastname: de Jong
mesh_terms: D000367:Age Factors; D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging*; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D018572:Disease-Free Survival; D055088:Early Detection of Cancer / Q000379:methods*; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D009426:Netherlands; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D013997:Time Factors