title: An increase in the coronary calcification score is associated with an increased risk of heart failure in patients without a history of coronary artery disease.
abstract: BACKGROUND
  The presence of coronary artery calcification (CAC) and its severity predict future cardiovascular events and is used for risk stratification. However, the association of CAC with heart failure (HF) in patients without a history of coronary artery disease (CAD) remains unclear. This study aimed to determine the correlations of CAC with N-terminal pro-B-type natriuretic peptide (NT-proBNP) and HF events in patients without a history of CAD or HF.
  
  
  METHODS
  From June 2010 to June 2013, a total of 487 patients without a history of CAD and HF were enrolled. All of the patients underwent plane multi-detector computed tomography. They were divided into four categories according to CAC scores: ≤10, 11-100, 101-400, and ≥401.
  
  
  RESULTS
  The proportion of patients with high NT-proBNP levels increased with CAC categories (p<0.0001). The CAC score was associated with NT-proBNP levels ≥400pg/ml, with an odds ratio of 2.901 (95% confidence interval: 1.368-6.151, p=0.0055) for CAC scores ≥401 compared with CAC scores of 0-10 after adjustment for confounding factors. During the follow-up period of 497±315 days, nine patients were admitted for HF. Kaplan-Meier analysis showed that patients with CAC scores ≥401 had a lower rate of freedom from admission for HF with cumulative incidences of 0.4%, 1%, 2%, and 8% for CAC scores of 0-10, 11-100, 101-400, and ≥401, respectively (p<0.0001). Increasing CAC scores were associated with an increase in incidence of admission for HF, with a hazard ratio of 10.371 for CAC scores ≥401 (95% CI: 1.062-101.309, p=0.0443) compared with CAC scores of 0-10 after adjustment for risk factors.
  
  
  CONCLUSIONS
  Severe CAC is an independent determinant of high NT-proBNP levels and a predictor of admission for HF in a population without a history of CAD or HF.
authors.affiliation: Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan. Electronic address: s-sakura@sc4.so-net.ne.jp.
authors.forename: Satoru
authors.initials: S
authors.lastname: Sakuragi
authors.affiliation: Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan.
authors.forename: Keishi
authors.initials: K
authors.lastname: Ichikawa
authors.affiliation: Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Yamada
authors.affiliation: Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Tanimoto
authors.affiliation: Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Miki
authors.affiliation: Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Otsuka
authors.affiliation: Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Yamamoto
authors.affiliation: Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Kawamoto
authors.affiliation: Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Katayama
authors.affiliation: Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan.
authors.forename: Machiko
authors.initials: M
authors.lastname: Tanakaya
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medical and Dentistry, Okayama, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ito
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002114:Calcinosis / Q000150:complications* / Q000473:pathology; D003324:Coronary Artery Disease / Q000150:complications* / Q000473:pathology; D005260:Female; D006333:Heart Failure / Q000209:etiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D016017:Odds Ratio; D010446:Peptide Fragments / Q000097:blood; D016016:Proportional Hazards Models; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Coronary artery calcification; Heart failure; N-terminal pro-B-type natriuretic peptide