Brar Sandeep, Goli Rahul, Barrios Joshua P, Blaha Michael J, Kianoush Sina, Pletcher Mark J, Nomura Sarah O, Tsai Michael Y, Duan Rong, Budoff Matthew J, Szklo Moyses, Tison Geoffrey H
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, San Francisco, California, USA.
Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
JACC Heart Fail. 2025 May;13(5):740-751. doi: 10.1016/j.jchf.2024.12.007. Epub 2025 Mar 26.
Extracoronary calcification (ECC) is a prevalent cardiovascular risk factor.
The aim of this study was to examine the association between ECC and heart failure (HF), including heart failure with preserved ejection fraction (HFpEF).
MESA (Multi-Ethnic Study of Atherosclerosis) participants with computed tomographic imaging at baseline for calcification of the aortic valve, aortic root, mitral valve, and thoracic aorta were included. ECC score was calculated by rescaling Agatston scores from 0 to 1 for each ECC site and summing the rescaled scores. Multivariable Cox proportional hazards regression was performed to examine the association between ECC quartiles and incident HF.
Of all MESA participants, 3,617 (53.1%) and 3,192 (46.9%) had ECC scores of 0 and >0, respectively. During a mean follow-up period of 12.9 ± 4.2 years, 358 HF events were observed, 179 HF with reduced ejection fraction and 135 HFpEF. After controlling for demographics and risk factors, the highest ECC quartile (compared with the lowest quartile) had 1.7-fold greater hazard of incident HF (adjusted HR: 1.72 [95% CI: 1.16-2.55]; P = 0.007), though this was attenuated to borderline significance after additional adjustment for coronary artery calcification. In contrast for HFpEF, the highest ECC quartile (compared with the lowest quartile) remained independently and statistically significantly associated with 3-fold greater hazard of incident HFpEF (adjusted HR: 3.09 [95% CI: 1.45-6.60]; P = 0.003) after full adjustment, including for coronary artery calcification.
ECC is associated with increased risk for HF, in particular HFpEF. If this finding is confirmed in other studies, ECC could help improve traditional risk factor estimation and clinical risk assessments for HF and HFpEF.
冠状动脉外钙化（ECC）是一种常见的心血管危险因素。
本研究旨在探讨ECC与心力衰竭（HF）之间的关联，包括射血分数保留的心力衰竭（HFpEF）。
纳入多民族动脉粥样硬化研究（MESA）中在基线时进行了主动脉瓣、主动脉根部、二尖瓣和胸主动脉钙化计算机断层扫描成像的参与者。ECC评分通过将每个ECC部位的阿加斯顿评分从0重新标度为1并将重新标度后的分数相加来计算。进行多变量Cox比例风险回归以检验ECC四分位数与新发HF之间的关联。
在所有MESA参与者中，分别有3617名（53.1%）和3192名（46.9%）的ECC评分为0和>0。在平均12.9±4.2年的随访期内，观察到358例HF事件，其中179例为射血分数降低的HF，135例为HFpEF。在控制了人口统计学和危险因素后，最高ECC四分位数（与最低四分位数相比）发生HF的风险高1.7倍（调整后HR：1.72[95%CI：1.16 - 2.55]；P = 0.007），不过在对冠状动脉钙化进行额外调整后，这一结果减弱至临界显著性。相比之下，对于HFpEF，在进行全面调整（包括冠状动脉钙化）后，最高ECC四分位数（与最低四分位数相比）与新发HFpEF风险高3倍仍独立且具有统计学显著关联（调整后HR：3.09[95%CI：1.45 - 6.60]；P = 0.003）。
ECC与HF风险增加相关，尤其是HFpEF。如果这一发现能在其他研究中得到证实，ECC有助于改善HF和HFpEF的传统危险因素评估及临床风险评估。
