Mahjoub Haïfa, Mathieu Patrick, Larose Eric, Dahou Abdelaziz, Sénéchal Mario, Dumesnil Jean-Gaston, Després Jean-Pierre, Pibarot Philippe
Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Laval University, Québec, Canada.
Heart. 2015 Mar;101(6):472-7. doi: 10.1136/heartjnl-2014-306445. Epub 2015 Jan 24.
Cusp calcification is the main mechanism leading to bioprosthetic heart valve (BPV) failure. Recent studies suggest that BPV calcification is an active rather than passive process probably modulated by several mechanisms including lipid-mediated inflammation and dysfunctional phosphocalcic metabolism.
To identify the clinical and metabolic determinants of BPV calcification assessed by multidetector CT (MDCT).
Presence of BPV calcification was assessed by MDCT in 194 patients who had undergone aortic valve replacement. A calcification score was individually calculated and expressed in mm(3). Patients also underwent a clinical evaluation, a Doppler echocardiographic exam, and a plasma lipid and phosphocalcic profile. 46 patients (24%) had BPV calcification (cusp calcification score >0 mm(3)). After adjustment for age, gender, and time interval since BPV implantation, increased calcium-phosphorus product (OR 1.11, 95% CI 1.01 to 1.23 per 1 unit; p=0.02) and the presence of prosthesis-patient mismatch (OR 3.67, 95% CI 1.25 to 10.6; p=0.01) were the strongest independent factors associated with BPV calcification. Calcium supplement intake, age and female gender were independently associated with increased calcium-phosphorus product.
This study suggests that higher calcium-phosphorus product and prosthesis-patient mismatch promote BPV calcification. Furthermore, this study reports that calcium supplements, which are extensively prescribed in elderly patients, are independently associated with higher calcium-phosphorus product.
瓣叶钙化是导致生物人工心脏瓣膜（BPV）功能障碍的主要机制。近期研究表明，BPV钙化是一个主动而非被动的过程，可能受多种机制调节，包括脂质介导的炎症和磷酸钙代谢功能失调。
确定通过多排螺旋CT（MDCT）评估的BPV钙化的临床和代谢决定因素。
对194例接受主动脉瓣置换术的患者进行MDCT检查，评估BPV钙化情况。分别计算钙化评分并以mm³表示。患者还接受了临床评估、多普勒超声心动图检查以及血脂和磷酸钙水平检测。46例患者（24%）存在BPV钙化（瓣叶钙化评分>0 mm³）。在调整年龄、性别和BPV植入后的时间间隔后，钙磷乘积升高（每单位OR 1.11，95% CI 1.01至1.23；p=0.02）以及存在人工瓣膜-患者不匹配（OR 3.67，95% CI 1.25至10.6；p=0.01）是与BPV钙化相关的最强独立因素。钙补充剂摄入、年龄和女性性别与钙磷乘积升高独立相关。
本研究表明，较高的钙磷乘积和人工瓣膜-患者不匹配会促进BPV钙化。此外，本研究报告称，老年患者广泛使用的钙补充剂与较高的钙磷乘积独立相关。
