Determinants and prognosis of aortic valve calcification in conjunction with carotid atherosclerosis and left ventricular function

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Aortic valve (AV) sclerosis is known as a progressive atherosclerotic disease causing aortic stenosis (AS). However, its contributors and prognostic value in patients without overt AS have not been well investigated. Purpose In this study, we sought to evaluate its determinants and prognostic value in conjunction with carotid atherosclerosis and left ventricular (LV) function. Methods Consecutive 4,689 patients who underwent both carotid ultrasound and echocardiography were followed during 3.6 ± 1.3 years after exclusion of patients with bicuspid aortic valve (n=12), rheumatic heart disease (n=7), overt AS (n=62) and AV replacement status (n=10). AV sclerosis was classified as pure AV sclerosis and AV sclerocalcification according to cusp thickening and presence of hyper-echogenicity in any cusps. Results Their mean age was 61.1±11.7 years and 1,836 (39%) were women. Of them 2,003 (43%) had pure AV sclerosis and 523 (11%) had AV sclerocalcification. Presence of AV sclerocalcification was independently correlated with age, presence and degree of carotid plaques, ventricular septal thickness, high density lipoprotein level and presence of atrial fibrillation. Presence of AV sclerocalcification was significantly related with composite cardiovascular events (all CVE, unstable angina, acute myocardial infarction and all cause death; log rank p = 0.011) and future heart failure (HF) admission (p<0.001) but not with pure AV sclerosis. In multivariate analysis, presence of carotid plaques was most strongly associated with all CVE, however when adding AV sclerocalcification on carotid plaques, it added the significant prognostic values (p = 0.015). Regarding future HF admission, the significance was attenuated after introducing left atrial volume index and LV ejection fraction. Conclusions AV sclerocalcification has additive prognostic value on carotid plaque for future atherosclerotic events. Although, AV sclerocalcification was related to future HF admission it was mainly mediated by concomitant LV dysfunction, suggesting a surrogate marker rather than independent risk factor.