title: Aortic root, not valve, calcification correlates with coronary artery calcification in patients with severe aortic stenosis: A two-center study.
abstract: BACKGROUND
  The underlying pathology in aortic stenosis (AS) and coronary artery stenosis (CAS) is similar including atherosclerosis and calcification. We hypothesize that coronary artery calcification (CAC) is likely to correlate with aortic root calcification (ARC) rather than with aortic valve calcification (AVC), due to tissue similarity between the two types of vessel rather than with the valve leaflet tissue.
  
  
  METHODS
  We studied 212 consecutive patients (age 72.5 ± 7.9 years, 91 females) with AS requiring aortic valve replacement (AVR) in two Heart Centers, who underwent multidetector cardiac CT preoperatively. CAC, AVC and ARC were quantified using Agatston scoring. Correlations were tested by Spearman's test and Mann-Whitney U-test was used for comparing different subgroups; bicuspid (BAV) vs tricuspid (TAV) aortic valve.
  
  
  RESULTS
  CAC was present in 92%, AVC in 100% and ARC in 82% of patients. CAC correlated with ARC (rho = 0.51, p < 0.001) but not with AVC. The number of calcified coronary arteries correlated with ARC (rho = 0.45, p < 0.001) but not with AVC. 29/152 patients had echocardiographic evidence of BAV and 123 TAV, who were older (p < 0.001) but CAC was associated with TAV even after adjusting for age (p = 0.01). AVC score was associated with BAV after adjusting for age (p = 0.03) but ARC was not. Of the total cohort, 82 patients (39%) had significant coronary stenosis (>50%), but these were not different in the pattern of calcification from those without CAS. CAC was consistently higher in patients with risk factors for atherosclerosis compared to those without.
  
  
  CONCLUSIONS
  The observed relationship between coronary and aortic root calcification suggests a diffuse arterial disease. The lack of relationship between coronary and aortic valve calcification suggests a different pathology.
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Sweden. Electronic address: Michael.henein@umu.se.
authors.forename: Michael
authors.initials: M
authors.lastname: Henein
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Hällgren
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Holmgren
authors.affiliation: Department of Diagnostic Radiology, Umeå University Hospital, Sweden.
authors.forename: Karen
authors.initials: K
authors.lastname: Sörensen
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Sweden.
authors.forename: Pranvera
authors.initials: P
authors.lastname: Ibrahimi
authors.affiliation: Department of Cardiology and Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Klaus Fuglsang
authors.initials: KF
authors.lastname: Kofoed
authors.affiliation: Department of Cardiology and Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Linnea Hornbech
authors.initials: LH
authors.lastname: Larsen
authors.affiliation: Department of Cardiology and Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Hassager
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000473:pathology*; D001018:Aortic Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000473:pathology*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging*; D001027:Aortography / Q000379:methods*; D000082882:Bicuspid Aortic Valve Disease; D002114:Calcinosis / Q000150:complications / Q000000981:diagnostic imaging*; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D003718:Denmark; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index; D013548:Sweden; D061205:Vascular Calcification / Q000150:complications / Q000000981:diagnostic imaging*
keywords: Aortic root calcification; Aortic stenosis; Aortic valve calcification; Coronary artery calcification