Utsunomiya Hiroto, Yamamoto Hideya, Urabe Yoji, Tsushima Hiroshi, Kunita Eiji, Kitagawa Toshiro, Hidaka Takayuki, Kihara Yasuki
Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
Int J Cardiol Heart Vessel. 2013 Nov 26;2:15-20. doi: 10.1016/j.ijchv.2013.11.007. eCollection 2013 Mar.
Echocardiography can detect calcium deposits in heart valves and aortic root, but the relationship of echocardiographic heart calcification such as aortic valve calcification (AVC), mitral annular calcification (MAC), and aortic root calcification (ARC) with future cardiovascular disease (CVD) mortality and morbidity is not fully elucidated.
We analyzed data from 943 patients with suspected coronary heart disease (mean age, 65.7 years; 36% female). Echocardiographic total heart calcification (THC) score was determined by summing up the AVC, MAC, and ARC variables; THC-0 (N = 397), THC-1 (N = 236), THC-2 (N = 224), and THC-3 (N = 86). Subjects were followed for mean 2.9 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.
There were 43 CVD deaths and a total of 160 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% confidence intervals) for CVD mortality and morbidity, using no calcification as reference, for THC-1, THC-2, and THC-3 were 2.21 (1.31-3.74), 2.59 (1.53-4.39) and 4.14 (2.30-7.47), respectively. When THC score was added to models with CVD risk factors, C-statistics were significantly larger for CVD mortality (p = 0.048) and for CVD mortality and morbidity (p = 0.004).
THC score, the sum of the amounts of AVC, MAC, and ARC present as estimated by echocardiography, has an independent and incremental prognostic value in a high-risk population.
超声心动图可检测心脏瓣膜和主动脉根部的钙沉积，但超声心动图检测到的心脏钙化，如主动脉瓣钙化（AVC）、二尖瓣环钙化（MAC）和主动脉根部钙化（ARC）与未来心血管疾病（CVD）死亡率和发病率之间的关系尚未完全阐明。
我们分析了943例疑似冠心病患者的数据（平均年龄65.7岁；36%为女性）。超声心动图心脏总钙化（THC）评分通过将AVC、MAC和ARC变量相加得出；THC-0（n = 397）、THC-1（n = 236）、THC-2（n = 224）和THC-3（n = 86）。对受试者进行平均2.9年的随访，以评估CVD病因导致的死亡风险。心血管疾病发病率定义为非致命性心肌梗死、充血性心力衰竭、中风和血管疾病外科治疗的新发病例。
有43例CVD死亡，共160例CVD事件。Kaplan-Meier曲线显示，随着THC评分值的增加，CVD死亡率和发病率呈分级变化。经过全面调整后，以无钙化为参照，Cox回归风险比（95%置信区间）显示，THC-1、THC-2和THC-3的CVD死亡率和发病率分别为2.21（1.31 - 3.74）、2.59（1.53 - 4.39）和4.14（2.30 - 7.47）。当将THC评分添加到具有CVD危险因素的模型中时，CVD死亡率（p = 0.048）以及CVD死亡率和发病率（p = 0.004）的C统计量显著增大。
THC评分，即超声心动图估计的AVC、MAC和ARC数量之和，在高危人群中具有独立的增量预后价值。
