Institute for Community Medicine, Ernst Moritz Arndt University Greifswald, Walther Rathenau Str. 48, D-17487 Greifswald, Germany.
Atherosclerosis. 2010 Apr;209(2):606-10. doi: 10.1016/j.atherosclerosis.2009.10.030. Epub 2009 Oct 29.
Aortic valve sclerosis (AVS) and mitral annulus calcification (MAC) might predict future adverse events. We undertook the present study to investigate the association of AVS and MAC with all-cause and cardiovascular mortality. We further studied whether a combined presence of AVS and MAC is more strongly associated with mortality than the single items and sought to disclose possible gender differences in the investigated associations.
We used data from 2081 participants aged > or =45 years (1063 women) of the Study of Health in Pomerania (SHIP). AVS and MAC were determined echocardiographically, and a heart valve sclerosis score was calculated by summing up the AVS and MAC variables. The median duration of mortality follow-up was 8.6 years (17,162 person-years).
There were 528 subjects (25.4%) with isolated AVS, 35 with isolated MAC (1.7%) and 89 with both AVS and MAC (4.3%). A total number of 228 deaths (11.0%) occurred during follow-up, including 133 (21.6%) with AVS and 95 subjects (6.5%) without AVS (incidence rate ratio 3.49, 95% CI 2.77; 4.40, p<0.001). Likewise, mortality rates were higher for subjects with MAC than subjects without MAC (incidence rate ratio 3.79, 95% CI 2.82; 5.02, p<0.001). Multivariable analyses revealed that the associations of AVS and MAC with all-cause and cardiovascular mortality were independent of major confounders and strongest for highest values of the heart valve sclerosis score. AVS-related mortality was more pronounced in women than in men.
AVS and MAC are associated with all-cause and cardiovascular mortality. The association between AVS and mortality is gender-specific with women with AVS being at a higher mortality risk than men with AVS. The summation of AVS and MAC to a heart valve sclerosis score improves the predictability with respect to mortality.
主动脉瓣硬化（AVS）和二尖瓣环钙化（MAC）可能预测未来的不良事件。本研究旨在探讨 AVS 和 MAC 与全因和心血管死亡率的关系。我们进一步研究了 AVS 和 MAC 的共同存在是否比单项指标与死亡率的相关性更强，并试图揭示所研究的相关性中可能存在的性别差异。
我们使用了来自年龄≥45 岁的 2081 名参与者（女性 1063 名）的波罗的海健康研究（SHIP）的数据。通过超声心动图确定 AVS 和 MAC，并通过将 AVS 和 MAC 变量相加来计算心脏瓣膜硬化评分。死亡率随访的中位时间为 8.6 年（17162 人年）。
共有 528 名受试者（25.4%）存在孤立性 AVS，35 名受试者（1.7%）存在孤立性 MAC，89 名受试者（4.3%）存在 AVS 和 MAC 并存。随访期间共发生 228 例死亡（11.0%），其中 133 例（21.6%）有 AVS，95 例（6.5%）无 AVS（发病率比 3.49，95%置信区间 2.77；4.40，p<0.001）。同样，MAC 患者的死亡率高于无 MAC 患者（发病率比 3.79，95%置信区间 2.82；5.02，p<0.001）。多变量分析表明，AVS 和 MAC 与全因和心血管死亡率的相关性独立于主要混杂因素，且与心脏瓣膜硬化评分的最高值相关性最强。AVS 相关死亡率在女性中比男性更为明显。
AVS 和 MAC 与全因和心血管死亡率相关。AVS 与死亡率的相关性具有性别特异性，患有 AVS 的女性比患有 AVS 的男性死亡率更高。将 AVS 和 MAC 相加得到心脏瓣膜硬化评分可提高对死亡率的预测能力。
