The prognostic significance of echocardiographic heart calcifications on cardiovascular morbidity and mortality in patients with known coronary heart disease

Introduction: Echocardiography can detect calcium deposits in aortic root and heart valves. The relationship between echocardiographic heart calcifications, such as aortic root calcification (ARC), aortic valve calcification (AVC), mitral annular calcification (MAC), and cardiovascular disease (CVD), and mortality and morbidity is not elucidated. Methods: We analyzed data from 500 patients with known coronary heart disease (mean age 62.5 years; 42% female). Echocardiographic total heart calcification (THC) score was determined by summing up the AVC, MAC, and ARC variables; THC-0 (N = 152), THC-1 (N = 136), THC-2 (N = 128), and THC-3 (N = 84). Subjects were followed for mean 2 years to assess the risk of death from CVD causes. Cardiovascular morbidity was defined as new episodes of non-fatal myocardial infarction, congestive heart failure, stroke, and surgical treatment of vascular disease. Results: There were 21 CVD deaths and a total of 102 CVD events. Kaplan–Meier curves showed a graded CVD mortality and morbidity across increasing THC score values. With full adjustment, Cox regression hazard ratios (95% confi dence intervals) for CVD mortality and morbidity, using no calcification as reference, for THC-1, THC-2, and THC-3 were 2.19 (1.29–3.62), 2.62 (1.51–4.21) and 4.07 (2.21–6.42), respectively. When THC score was added to models with CVD risk factors, C-statistics were significantly larger for CVD mortality (p = 0.037) and for CVD mortality and morbidity (p = 0.002). Conclusions: THC score, the sum of the amounts of calcifications at the level of mitral, aortic valve and aortic root, estimated by echocardiography, has an independent prognostic value in cardiovascular morbidity and mortality in patients with known coronary heart disease.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)