title: Usefulness of an Echocardiographic Composite Cardiac Calcium Score to Predict Death in Patients With Stable Coronary Artery Disease (from the Heart and Soul Study).
abstract: Mitral annular calcium and aortic valve sclerosis on transthoracic echocardiography (TTE) are independently associated with cardiovascular (CV) events in patients with coronary artery disease (CAD). However, the prognostic value of calcific deposits at multiple sites is unknown. We performed TTEs in a prospective cohort of 595 outpatients with stable CAD and graded the severity of calcific deposition at 6 sites: mitral annulus, aortic valve, aortic ring, sinotubular junction, papillary muscle tip, and left main coronary artery. For each site with moderate calcific deposition or greater, 1 point was given to generate a composite cardiac calcium score (maximum of 6). The primary end point was the occurrence of CV events-a composite of death, myocardial infarction, stroke, transient ischemic attack, and heart failure. The association of the composite calcium score with CV events was evaluated using multivariate Cox proportional hazards models. Over a median follow-up of 4.2 years, 205 CV events occurred. Participants with a composite calcium score ≥2 had a higher risk of CV events (11.1 events/100 person-years) than those with a score of 0 (5.5 events/100 person-years, unadjusted hazard ratio [HR] 2.01, p <0.001), but this association was not significant after multivariate adjustment. The risk of death was higher in participants with a composite calcium score of ≥2 (8.9 events/100 person-years) versus those with a score of 0 (3.6 events/100 person-years, unadjusted HR 2.51, p <0.001). After adjustment for age, diabetes mellitus, previous coronary revascularization, diastolic blood pressure, estimated glomerular filtration rate, and serum phosphorus level, the risk of death remained higher in participants with a composite calcium score of ≥2 compared with those with a score of 0 (adjusted HR 1.76, 95% confidence interval 1.10 to 2.81, p = 0.02). In conclusion, a simple TTE-derived composite cardiac calcium score was independently predictive of death in patients with pre-existing CAD.
authors.affiliation: Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, Illinois. Electronic address: sandeep_a_saha@rush.edu.
authors.forename: Sandeep A
authors.initials: SA
authors.lastname: Saha
authors.affiliation: Division of Cardiology, University of Washington and Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
authors.forename: Alexis L
authors.initials: AL
authors.lastname: Beatty
authors.affiliation: Veterans' Affairs Medical Center, San Francisco, California; Division of Cardiology, Department of Medicine, University of California, San Francisco, California.
authors.forename: Rakesh K
authors.initials: RK
authors.lastname: Mishra
authors.affiliation: Veterans' Affairs Medical Center, San Francisco, California; Division of Cardiology, Department of Medicine, University of California, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Whooley
authors.affiliation: Veterans' Affairs Medical Center, San Francisco, California; Division of Cardiology, Department of Medicine, University of California, San Francisco, California.
authors.forename: Nelson B
authors.initials: NB
authors.lastname: Schiller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging*; D002114:Calcinosis / Q000000981:diagnostic imaging; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D010045:Outpatients / Q000706:statistics & numerical data; D010210:Papillary Muscles / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D061205:Vascular Calcification / Q000000981:diagnostic imaging* / Q000401:mortality