title: Cardiac Calcifications on Echocardiography Are Associated with Mortality and Stroke.
abstract: Calcium deposits in the aortic valve and mitral annulus have been associated with cardiovascular events and mortality. However, there is no accepted standard method for scoring such cardiac calcifications, and most existing methods are simplistic. The aim of this study was to test the hypothesis that a semiquantitative score, one that accounts for all visible calcium on echocardiography, could predict all-cause mortality and stroke in a graded fashion.
  
  
  
  This was a retrospective study of 443 unselected subjects derived from a general echocardiography database. A global cardiac calcium score (GCCS) was applied that assigned points for calcification in the aortic root and valve, mitral annulus and valve, and submitral apparatus, and points for restricted leaflet mobility. The primary outcome was all-cause mortality, and the secondary outcome was stroke.
  
  
  
  Over a mean 3.8 ± 1.7 years of follow-up, there were 116 deaths and 34 strokes. Crude mortality increased in a graded fashion with increasing GCCS. In unadjusted proportional hazard analysis, the GCCS was significantly associated with total mortality (hazard ratio, 1.26; 95% CI, 1.17-1.35; P < .0001) and stroke (hazard ratio, 1.23; 95% CI, 1.07-1.40; P = .003). After adjusting for demographic and clinical factors (age, gender, body mass index, diabetes, hypertension, dyslipidemia, smoking, family history of coronary disease, chronic kidney disease, history of atrial fibrillation, and history of stroke), these associations remained significant.
  
  
  
  The GCCS is easily applied to routinely acquired echocardiograms and has clinically significant associations with total mortality and stroke.
authors.affiliation: Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania.
authors.forename: Marvin Louis Roy
authors.initials: ML
authors.lastname: Lu
authors.affiliation: Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, Pennsylvania.
authors.forename: Shuchita
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, Pennsylvania.
authors.forename: Abel
authors.initials: A
authors.lastname: Romero-Corral
authors.affiliation: International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic.
authors.forename: Magdaléna
authors.initials: M
authors.lastname: Matejková
authors.affiliation: Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania.
authors.forename: Toni
authors.initials: T
authors.lastname: De Venecia
authors.affiliation: Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, Pennsylvania.
authors.forename: Edinrin
authors.initials: E
authors.lastname: Obasare
authors.affiliation: Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, Pennsylvania.
authors.forename: Vikas
authors.initials: V
authors.lastname: Bhalla
authors.affiliation: Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, Pennsylvania. Electronic address: pressmang@einstein.edu.
authors.forename: Gregg S
authors.initials: GS
authors.lastname: Pressman
mesh_terms: D017677:Age Distribution; D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000401:mortality*; D015984:Causality; D015897:Comorbidity; D004452:Echocardiography / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010414:Pennsylvania / Q000453:epidemiology; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D020521:Stroke / Q000000981:diagnostic imaging* / Q000401:mortality*; D015996:Survival Rate; D061205:Vascular Calcification / Q000000981:diagnostic imaging* / Q000401:mortality*
keywords: Echocardiography; Global cardiac calcium score