Abstract
AimsValvular heart disease can be identified by calcification on coronary computed tomography angiography (CCTA) and has been associated with adverse clinical outcomes. We assessed aortic and mitral valve calcification in patients presenting with stable chest pain and their association with cardiovascular risk factors, coronary artery disease, and cardiovascular outcomes.Methods and resultsIn 1769 patients (58 ± 9 years, 56% male) undergoing CCTA for stable chest pain, aortic and mitral valve calcification were quantified using Agatston score. Aortic valve calcification was present in 241 (14%) and mitral calcification in 64 (4%). Independent predictors of aortic valve calcification were age, male sex, hypertension, diabetes mellitus, and cerebrovascular disease, whereas the only predictor of mitral valve calcification was age. Patients with aortic and mitral valve calcification had higher coronary artery calcium scores and more obstructive coronary artery disease. The composite endpoint of cardiovascular mortality, non-fatal myocardial infarction, or non-fatal stroke was higher in those with aortic [hazard ratio (HR) 2.87; 95% confidence interval (CI) 1.60–5.17; P < 0.001] or mitral (HR 3.50; 95% CI 1.47–8.07; P = 0.004) valve calcification, but this was not independent of coronary artery calcification or obstructive coronary artery disease.ConclusionAortic and mitral valve calcification occurs in one in six patients with stable chest pain undergoing CCTA and is associated with concomitant coronary atherosclerosis. Whilst valvular calcification is associated with a higher risk of cardiovascular events, this was not independent of the burden of coronary artery disease.
Highlights
Valvular heart disease is an important cause of morbidity and mortality worldwide and shares similar risk factors with coronary artery disease.[1]
Aortic valve calcification is an established marker of aortic stenosis, with the aortic valve calcium score on computed tomography (CT) associated with hemodynamic severity of aortic stenosis on echocardiography.[8,9,10]
Previous studies have suggested that patients with aortic stenosis and mitral valve calcification have an increased frequency of cardiovascular mortality beyond that related to the valve, including an increased risk of myocardial infarction (MI) and stroke, the mechanisms underlying these associations remain unclear.[7,16,17]
Summary
Valvular heart disease is an important cause of morbidity and mortality worldwide and shares similar risk factors with coronary artery disease.[1] Incidental calcification of the aortic or mitral valve on computed tomography (CT) may identify patients with previously undiagnosed valvular heart disease. Coronary CT angiography (CCTA) is a widely used non-invasive imaging modality, frequently the first-line investigation for patients with suspected coronary artery disease.[2,3] the identification of incidental valvular calcification on CCTA represents a potentially important opportunity for screening and patient risk stratification.[4,5,6,7]. Mitral valve annular calcification is a frequent finding on CCTA and may be associated with mitral valve dysfunction.[14,15] Previous studies have suggested that patients with aortic stenosis and mitral valve calcification have an increased frequency of cardiovascular mortality beyond that related to the valve, including an increased risk of myocardial infarction (MI) and stroke, the mechanisms underlying these associations remain unclear.[7,16,17]
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