Division of Cardiac Imaging, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
Division of Cardiac Imaging, Department of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Curr Atheroscler Rep. 2022 Oct;24(10):755-766. doi: 10.1007/s11883-022-01051-5. Epub 2022 Aug 30.
The coronary artery calcium score is a guideline-endorsed aid for further risk stratification in the primary prevention of atherosclerotic cardiovascular disease. The non-contrast scan performed for detection of coronary artery calcium also gives an opportunity to visualize calcifications in the thoracic aorta and in the heart valves, at no additional cost or radiation exposure. The purpose of this review was to discuss the potential clinical value of measuring thoracic aortic calcification, aortic valve calcification, and mitral annulus calcification.
After two decades of active research, all three calcifications have been extensively evaluated, across various cohorts. We discuss classic and recent studies, current knowledge gaps, and future directions in this space. The added value of these measurements has traditionally been considered modest at best, and they are not currently discussed in relevant primary prevention guidelines in North America and Europe. However, recent studies evaluating high thoracic calcification thresholds and younger populations have further enriched this space. Specifically, some studies suggest that detection of severe thoracic aortic calcification may be helpful in further risk assessment and that detection of aortic valve calcifications may have important prognostic implications in younger individuals. Although more research is needed, particularly in larger young-to-middle-aged cohorts, future guidelines might consider including these features as risk-enhancing factors.
冠状动脉钙评分是动脉粥样硬化性心血管疾病一级预防中进一步风险分层的指南推荐辅助手段。非对比扫描用于检测冠状动脉钙，也可以在不增加费用或辐射暴露的情况下，观察胸主动脉和心脏瓣膜的钙化。本综述的目的是讨论测量胸主动脉钙化、主动脉瓣钙化和二尖瓣环钙化的潜在临床价值。
经过二十年的积极研究，这三种钙化在各种队列中都得到了广泛的评估。我们讨论了经典和最近的研究、当前的知识空白以及该领域的未来方向。这些测量的附加值传统上被认为是适度的，它们目前在北美的相关一级预防指南和欧洲的相关一级预防指南中并未讨论。然而，最近评估高胸钙化阈值和年轻人群的研究进一步丰富了这一领域。具体来说，一些研究表明，严重胸主动脉钙化的检测可能有助于进一步的风险评估，而年轻个体中主动脉瓣钙化的检测可能具有重要的预后意义。尽管需要更多的研究，特别是在更大的年轻到中年人群中，但未来的指南可能会考虑将这些特征作为增强风险的因素。
