Whelton Seamus P, Jha Kunal, Dardari Zeina, Razavi Alexander C, Boakye Ellen, Dzaye Omar, Verghese Dhiran, Shah Sanjiv, Budoff Matthew J, Matsushita Kunihiro, Carr J Jeffery, Vasan Ramachandran S, Blumenthal Roger S, Anchouche Khalil, Thanassoulis George, Guo Xiuqing, Rotter Jerome I, McClelland Robyn L, Post Wendy S, Blaha Michael J
Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
JACC Cardiovasc Imaging. 2024 Jan;17(1):31-42. doi: 10.1016/j.jcmg.2023.02.018. Epub 2023 May 10.
Aortic valve calcification (AVC) is a principal mechanism underlying aortic stenosis (AS).
This study sought to determine the prevalence of AVC and its association with the long-term risk for severe AS.
Noncontrast cardiac computed tomography was performed among 6,814 participants free of known cardiovascular disease at MESA (Multi-Ethnic Study of Atherosclerosis) visit 1. AVC was quantified using the Agatston method, and normative age-, sex-, and race/ethnicity-specific AVC percentiles were derived. The adjudication of severe AS was performed via chart review of all hospital visits and supplemented with visit 6 echocardiographic data. The association between AVC and long-term incident severe AS was evaluated using multivariable Cox HRs.
AVC was present in 913 participants (13.4%). The probability of AVC >0 and AVC scores increased with age and were generally highest among men and White participants. In general, the probability of AVC >0 among women was equivalent to men of the same race/ethnicity who were approximately 10 years younger. Incident adjudicated severe AS occurred in 84 participants over a median follow-up of 16.7 years. Higher AVC scores were exponentially associated with the absolute risk and relative risk of severe AS with adjusted HRs of 12.9 (95% CI: 5.6-29.7), 76.4 (95% CI: 34.3-170.2), and 380.9 (95% CI: 169.7-855.0) for AVC groups 1 to 99, 100 to 299, and ≥300 compared with AVC = 0.
The probability of AVC >0 varied significantly by age, sex, and race/ethnicity. The risk of severe AS was exponentially higher with higher AVC scores, whereas AVC = 0 was associated with an extremely low long-term risk of severe AS. The measurement of AVC provides clinically relevant information to assess an individual's long-term risk for severe AS.
主动脉瓣钙化（AVC）是主动脉瓣狭窄（AS）的主要潜在机制。
本研究旨在确定AVC的患病率及其与严重AS长期风险的关联。
在动脉粥样硬化多族裔研究（MESA）的第1次访视中，对6814名无已知心血管疾病的参与者进行了非增强心脏计算机断层扫描。使用阿加斯顿方法对AVC进行量化，并得出按年龄、性别和种族/族裔划分的标准化AVC百分位数。通过查阅所有医院就诊记录并补充第6次访视时的超声心动图数据来判定严重AS。使用多变量Cox风险比（HRs）评估AVC与长期发生严重AS之间的关联。
913名参与者（13.4%）存在AVC。AVC>0的概率和AVC评分随年龄增加，在男性和白人参与者中通常最高。一般而言，女性中AVC>0的概率与同一种族/族裔中年龄小约10岁的男性相当。在中位随访16.7年期间，84名参与者发生了经判定的严重AS。较高的AVC评分与严重AS的绝对风险和相对风险呈指数关联，与AVC = 0相比，AVC第1至99组、100至299组和≥300组的调整后HR分别为12.9（95%CI：5.6 - 29.7）、76.4（95%CI：34.3 - 170.2）和380.9（95%CI：169.7 - 855.0）。
AVC>0的概率因年龄、性别和种族/族裔而有显著差异。AVC评分越高，严重AS的风险呈指数级升高，而AVC = 0与极低的严重AS长期风险相关。AVC的测量为评估个体发生严重AS的长期风险提供了临床相关信息。
