Aortic valve sclerosis is associated with preclinical cardiovascular disease in hypertensive adults: the Hypertension Genetic Epidemiology Network study

Agno, Felizen S.; Chinali, Marcello; Bella, Jonathan N.; Liu, Jennifer E.; Arnett, Donna K.; Kitzman, Dalane W.; Oberman, Albert; Hopkins, Paul N.; Rao, D. C.; Devereux, Richard B.

doi:10.1097/01.hjh.0000163157.14493.c7

Cited by 30 publications

(14 citation statements)

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“…This fact has been already demonstrated in necropsy 1 and population studies, which have shown the occurrence of calcium deposits in the cardiovascular system of individuals with atherosclerotic disease. [2][3][4] TTE is a practical tool to assess cardiac calcium and its efficacy is comparable to that of angiotomography, as demonstrated in the Heinz Nixdorf Recall study, published in JAMA in 2010. 5 There is no standardization in regards to the quantification of cardiac calcium on TTE, and the present study used the Gaibazzi 6 score for this purpose.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] Similar to computed tomography (CT), bidimensional transthoracic echocardiography (TTE) is capable of detecting cardiac calcium deposits, and is a portable, noninvasive, nonradioactive, and low-cost method. 5 Coronary angiotomography is known to predict individual risk of coronary events, evaluating the calcium score of the coronary arteries and the semiquantitative scores of valvular calcium.…”

Section: Introductionmentioning

confidence: 99%

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Correlation Between Cardiac Calcium Index and Coronary Artery Disease

Sá¹,

Wermelinger²,

Rafael³

et al. 2017

International Journal of Cardiovascular Sciences

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ResumoIntroduction: Valvular deposits of calcium quantified by transthoracic echocardiography are associated with the occurrence of systemic atherosclerotic disease, but its prognostic value and influence of associated cardiovascular risk factors have not been defined yet.Objectives: To correlate the valvular cardiac calcium index by transthoracic echocardiography with cardiovascular risk factors and presence of coronary artery disease (CAD). Methods:We selected 203 patients (61.2 ± 14.3 years; 57.6% females) who underwent transthoracic echocardiography with cardiac calcium index quantification. The presence or absence of CAD, hypertension, diabetes mellitus (DM), dyslipidemia, and smoking was assessed.Results: Age above 65 years (p < 0.001) and the presence of hypertension (p < 0.001) showed a significant correlation with the presence of cardiac calcification, whereas DM (p = 0.056) and CAD (p = 0.08) showed only a trend toward a correlation with calcification. Mitral valve calcification alone correlated significantly with age above 65 years (p < 0.001), presence of CAD (p = 0.004), hypertension (p = 0.054), and DM (p = 0.07). On multivariate analysis, CAD (odds ratio [OR] 3.39, 95% confidence interval [95%CI] 1.58-7.29, p = 0.002) and age > 65 years (OR 1.05, 95%CI 1.02-1.08, p = 0.003) correlated significantly and independently with mitral valve calcification. Aortic valve calcification alone showed no correlation with the presence of CAD (p = 0.435), but correlated significantly with age above 65 years (p < 0.001) and hypertension (p < 0.001). On multivariate analysis, only age (OR 1.1, 95%CI 1.06-1.14, p < 0.001) remained independently and significantly correlated with aortic calcification. Conclusion:Age above 65 years and hypertension were independent risk factors for the presence of valvular cardiac calcification, with mitral valve calcification alone emerging as significantly and independently associated with the presence of CAD. (Int J Cardiovasc Sci. 2017;30(2):136-144)

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Correlation Between Cardiac Calcium Index and Coronary Artery Disease

Sá¹,

Wermelinger²,

Rafael³

et al. 2017

International Journal of Cardiovascular Sciences

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“…A single experienced reader (NBS), blinded to clinical history, physical examination, laboratory data, and outcome variables, interpreted all echocardiograms for aortic valve morphologic characteristics, sclerosis, and stenosis. Similar to other studies, 3,4 we defined aortic sclerosis as the presence of focal areas of aortic valve leaflet thickening and/or increased echogenicity with preserved leaflet mobility and a peak Doppler velocity across the aortic valve of <2.0 m/s. We found good intraobserver agreement for aortic valve morphologic characteristics during an intraobserver reliability analysis of 31 participants (κ = 0.62, 95% confidence interval [CI] 0.36 to 0.87).…”

Section: Methodsmentioning

confidence: 99%

“…3 Our results show that the presence of aortic sclerosis is a powerful predictor of MI events and adds further credence to the hypothesis that aortic sclerosis is a marker of atherosclerotic burden. Because patients with aortic sclerosis have more cardiac calcium and worse left ventricular function than those without aortic sclerosis, 4,7,17 it is important to account for echocardiographic differences when examining the association of aortic sclerosis with CV outcomes. We found that aortic sclerosis predicts MI even after adjustment for echocardiographic variables, including mitral annular calcium, exercise-induced ischemia, and left ventricular diastolic function.…”

Section: Discussionmentioning

confidence: 99%

Acute Myocardial Infarction in Patients With Versus Without Aortic Valve Sclerosis and Effect of Statin Therapy (from the Heart and Soul Study)

Shah

Ristow

Ali

et al. 2007

The American Journal of Cardiology

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Aortic sclerosis is associated with cardiovascular events in patients without coronary heart disease (CHD), but it is unclear whether this association exists in patients with established CHD or is independent of baseline cardiac disease severity. It is also unclear whether statins modify this association. In a prospective cohort study of 814 outpatients with established CHD and no evidence of aortic stenosis, the association of aortic sclerosis with subsequent cardiovascular events was examined using a multivariable Cox proportional hazards model. Of 814 participants, 324 (40%) had aortic sclerosis. During 4 years of follow-up, 10% with aortic sclerosis experienced a myocardial infarction (MI) compared with 5% of those without aortic sclerosis (hazard ratio [HR] 1.8, 95% confidence interval [CI] 1.1 to 3.1, p = 0.02). This association was unchanged after adjustment for potential confounders and mediators (HR 2.4, 95% CI 1.3 to 4.8, p = 0.009). However, the association between aortic sclerosis and MI appeared to differ by statin use (p = 0.15 for interaction). Aortic sclerosis predicted subsequent MI in subjects not administered statins (adjusted HR 4.1, 95% CI 1.1 to 15.7, p = 0.04), but not in those administered statins (adjusted HR 1.7, 95% CI 0.8 to 3.9, p = 0.18). In conclusion, aortic sclerosis was present in 40% of patients with CHD and is independently associated with a 2.4-fold increased rate of subsequent MI. Statins may attenuate the increased risk of future MI in patients with aortic sclerosis.We sought to determine whether the presence of aortic sclerosis, which has been associated with increased risk of cardiovascular (CV) events, 1-9 predicts adverse CV outcomes in patients with established coronary heart disease (CHD); whether this association is independent of baseline CV risk factors and cardiac disease severity; and whether statin therapy attenuates this association. In a cohort of 814 outpatients with established CHD followed for a median of 4 years, we examined the independent association of aortic sclerosis with subsequent myocardial infarction (MI), unstable angina, heart failure (HF), CHD death, and all-cause mortality. MethodsThe Heart and Soul Study is a prospective cohort study of psychosocial factors and health outcomes in patients with coronary disease. Methods and objectives have been previously described. [10][11][12] We used administrative databases to identify outpatients with documented coronary artery disease at 2 Department of Veterans Affairs Medical Centers (San Francisco Veterans Affairs Medical Center and Veterans Affairs Palo Alto Health Care System, California), 1 university medical center (University of California, San Francisco), and 9 public health clinics in the Community Health Network of San Francisco. Patients were eligible to participate if they had ≥1 of the following: a history of MI, angiographic evidence of ≥50% diameter stenosis of ≥1 coronary artery, previous evidence of exercise-induced ischemia using treadmill or nuclear testing, history of corona...

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“…These include inflammation [4,5], lipoprotein abnormalities [6] and endothelial dysfunction [7]. Furthermore, both large population-based studies [1] and subgroup analyses of cohorts of hypertensive patients [8,9] have shown that subjects with aortic sclerosis have increased LV wall thickness. In theory, coexistence of LV hypertrophy with aortic sclerosis may contribute to the increase in cardiovascular risk and therefore it is important to understand the mechanism for the increase in LV mass.…”

Section: Introductionmentioning

confidence: 99%