Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA.
Department of Medicine, Division of Cardiology, Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD, USA.
Eur Heart J Cardiovasc Imaging. 2021 Oct 19;22(11):1257-1263. doi: 10.1093/ehjci/jeaa336.
Aortic valve calcification (AVC) has been shown to be associated with increased cardiovascular disease (CVD) risk; however, whether this is independent of traditional risk factors and coronary artery calcification (CAC) remains unclear.
From the multicentre CAC Consortium database, 10 007 patients (mean 55.8±11.7 years, 64% male) with concomitant CAC and AVC scoring were included in the current analysis. AVC score was quantified using the Agatston score method and categorized as 0, 1-99, and ≥100. The endpoints were all-cause, CVD, and coronary heart disease (CHD) deaths. AVC (AVC>0) was observed in 1397 (14%) patients. During a median 7.8 (interquartile range: 4.7-10.6) years of study follow-up, 511 (5.1%) deaths occurred; 179 (35%) were CVD deaths, and 101 (19.8%) were CHD deaths. A significant interaction between CAC and AVC for mortality was observed (P<0.001). The incidence of mortality events increased with higher AVC; however, AVC ≥100 was not independently associated with all-cause, CVD, and CHD deaths after adjusting for CVD risk factors and CAC (P=0.192, 0.063, and 0.206, respectively). When further stratified by CAC<100 or ≥100, AVC ≥100 was an independent predictor of all-cause and CVD deaths only in patients with CAC <100, after adjusting for CVD risk factors and CAC [hazard ratio (HR): 1.93, 95% confidence interval (CI): 1.14-3.27; P=0.013 and HR: 2.71, 95% CI: 1.15-6.34; P=0.022, respectively].
Although the overall prognostic significance of AVC was attenuated after accounting for CAC, high AVC was independently associated with all-cause and CVD deaths in patients with low coronary atherosclerosis burden.
主动脉瓣钙化（AVC）与心血管疾病（CVD）风险增加相关；然而，其是否独立于传统危险因素和冠状动脉钙化（CAC）仍不清楚。
来自多中心 CAC 联盟数据库的 10007 例同时进行 CAC 和 AVC 评分的患者（平均年龄 55.8±11.7 岁，64%为男性）纳入本分析。使用 Agatston 评分法对 AVC 评分进行量化，并分为 0、1-99 和≥100。终点为全因、CVD 和冠心病（CHD）死亡。1397 例（14%）患者存在 AVC（AVC>0）。在中位 7.8 年（四分位距：4.7-10.6）的研究随访期间，有 511 例（5.1%）死亡；179 例（35%）为 CVD 死亡，101 例（19.8%）为 CHD 死亡。观察到 CAC 和 AVC 与死亡率之间存在显著交互作用（P<0.001）。随着 AVC 的增加，死亡率事件的发生率增加；然而，在校正 CVD 危险因素和 CAC 后，AVC≥100 与全因、CVD 和 CHD 死亡均无相关性（P=0.192、0.063 和 0.206）。当按 CAC<100 或≥100 进一步分层时，在校正 CVD 危险因素和 CAC 后，仅在 CAC<100 的患者中，AVC≥100 是全因和 CVD 死亡的独立预测因子[风险比（HR）：1.93，95%置信区间（CI）：1.14-3.27；P=0.013 和 HR：2.71，95% CI：1.15-6.34；P=0.022]。
尽管在考虑 CAC 后 AVC 的总体预后意义减弱，但在冠状动脉粥样硬化负担低的患者中，高 AVC 与全因和 CVD 死亡独立相关。
