Thoracic Aortic Calcification Research Articles

Inflammation and descending thoracic aortic calcification as detected by computed tomography: The Multi-Ethnic Study of Atherosclerosis

Background Inflammation is related to many stages of atherosclerosis, and inflammatory markers have been associated with both atherosclerosis and future cardiovascular events. Descending thoracic aortic calcification (DTAC) is a manifestation of atherosclerosis, however, no previous study has examined the relationship of inflammatory markers and DTAC as detected by computed tomography (CT) in a large study. We examined whether C-reactive protein (CRP) and interleukin-6 (IL-6) are independently associated with DTAC. Methods The Multi-Ethnic Study of Atherosclerosis (MESA) is a prospective cohort study that includes 6814 women and men ages 45–84 years old, all free of baseline cardiovascular disease. The inflammation markers CRP and IL-6, and DTAC by CT, quantified by Agatston score, were measured at baseline in all participants. Results We studied 6613 participants with complete data (3112 men, 3501 women, mean age 62 ± 10 years). The prevalence of DTAC was 27%. Participants with DTAC had significantly higher levels of both CRP and IL-6. After adjustment for baseline risk factors, CRP was not correlated with presence or severity of DTAC (Adjusted RR per S.D., 1.01; 95% confidence intervals 0.97; 1.05) while IL-6 associations remained significant (adjusted RR per S.D., 1.07; 95% confidence intervals 1.02; 1.14). Conclusions IL-6, a systemic inflammatory marker, is related to the presence and extent of DTAC. Further studies are needed to evaluate the interaction between DTAC and inflammation markers as predictors of future cardiovascular events.

Aortic Arch Calcification and Arterial Stiffness are Independent Factors for Diastolic Left Ventricular Dysfunction in Chronic Hemodialysis Patients

Because cardiovascular disease is the major cause of death in dialysis patients, the correlation between diastolic left ventricular (LV) dysfunction and arterial sclerosis, including thoracic aortic calcification, was studied in chronic hemodialysis (HD) patients. The enrolled study subjects were 142 (73 men, 69 women) maintenance HD patients. Aortic arch calcification volume (AoACV) was measured by MDCT scan, arterial stiffness was estimated by brachial-ankle pulse wave velocity (PWV) and diastolic LV function was estimated as E/E' by tissue Doppler imaging with cardiac ultrasonography. E/E' correlated significantly with systolic blood pressure (r=0.29, p=0.037), age (r=0.19, p=0.02), LV mass index (r=0.18, p=0.036), dialysis vintage (r=0.19, p=0.037), AoACV (r=0.37, p<0.0001) and PWV (r=0.33, p=0.0002). Multiple regression analysis indicated that AoACV (beta=0.26, p=0.005) and PWV (beta=0.22, p=0.03) were independent determinants of E/E'. Diastolic LV dysfunction may be induced by increased vascular calcification and reduced arterial stiffness in chronic HD patients.

Ethnic differences between extra-coronary measures on cardiac computed tomography: Multi-ethnic study of atherosclerosis (MESA)

Background Emerging evidence indicates that calcifications in valvular and thoracic aorta are manifestations of generalized atherosclerosis. Assessing the presence and extent of extra-coronary atherosclerosis may further improve prognostic information in subjects who are at risk for cardiovascular disease. The aim of the study is to determine the relative prevalence and quantity of extra-coronary calcifications across ethnic groups in a multi-ethnic population based cohort of asymptomatic individuals. Methods and results The ethnic differences associated with aortic valve calcification (AVC), mitral valve calcification (MVC), aortic valve root calcification (AVRC) and thoracic aortic wall calcification (TAC) were assessed in 6814 asymptomatic individuals in the multi-ethnic study of atherosclerosis (MESA) study. The overall prevalence of AVC, MVC, AVRC and TAC was 13, 10, 34 and 28%, respectively). As far as the valvular calcifications (AVC, MVC, AVRC) are concerned, the highest prevalence was observed in the Whites, followed by Hispanics and African-Americans with the lowest levels of calcification among the Chinese (all p < 0.001). On the other hand, the Chinese along with Whites had the highest prevalence of TAC ( p < 0.001). After adjustment for traditional CVD risk factors and coronary artery calcification, the relative risk of AVC compared with Whites was 0.72 in Blacks (95% CI 0.59–0.90), 1.03 in Hispanics (95% CI 0.82–1.28) and 0.56 in Chinese (95% CI 0.40–0.80). Similar associations were observed for the presence of MVC and AVRC. However, as compared to Whites, the relative risk for presence of TAC was not significantly lower among Hispanics (RR: 0.83, 95% CI: 0.68–1.01) and Chinese Americans (RR: 1.24, 95% CI: 0.95–0.1.62); however Blacks had a significantly lower risk of TAC (RR: 0.50, 95% CI: 0.41–0.60), respectively. Conclusions Racial differences exist in the prevalence of extra-coronary calcification in a large multi-ethnic population of asymptomatic individuals, thus underscoring the need for developing population specific nomograms to identify overall atherosclerotic burden in a more accurate manner in different ethnic groups. Further studies are needed to assess prognostic potential of each of these new measures of extra-coronary calcification in predicting subsequent cardiovascular events, independently and incrementally above known cardiovascular risk factors and the amount of calcified coronary plaque.

Abstract 3489: Presence of Thoracic Aorta Calcification Predicts All Cause Mortality Independent of Traditional Cardiovascular Risk Factors and Coronary Artery Calcification

Background: Recent guidelines have suggested that presence of coronary artery calcium (CAC) is an independent marker of adverse cardiovascular disease (CVD) events and mortality. However the predictive value of thoracic aorta calcification (TAC) that can be additionally identified without further scanning during assessment of CAC is unknown. Method: We followed a cohort of 8418 asymptomatic individuals (mean age: 53 ± 10 years, 69% men) undergoing cardiac risk factor evaluation and coronary calcium testing with electron-beam CT for median period of 5.0 years. Multivariable Cox proportional hazards models were developed to predict all-cause mortality obtained from the National Death Index with presence of TAC. Results: 141 (2%) all cause deaths were recorded. Overall survival was 96.7% and 98.8% for subjects with and without detectable TAC (p &lt; 0.0001). As compared to those with absent TAC (reference group) the hazard ratio for mortality for subjects with TAC was 3.07 (95% CI: 2.20 – 4.38) in unadjusted analyses (table ). After taking into account age, gender and CVD risk factors the association was reduced to 1.77 (95% CI: 1.11–2.29). The association of TAC with mortality remained statistically significant even after taking into account CAC (table ), although TAC appeared to predict events more strongly in the absence of CAC (HR: 2.81; 95% CI: 1.17– 6.79, p = 0.02) than with CAC &gt; 0 (HR: 1.39; 95% CI: 0.93–2.08, p = 0.10). However the interaction term between TAC and CAC for mortality was not significant (p = 0.23). Conclusions: Presence of TAC was associated with all-cause mortality in our study. This relationship was independent of conventional CVD risk factors and CAC. Hazard Ratio for All Cause Mortality with Presence of Thoracic Aorta Calcification

Effects of an aging vascular model on healthy and diseased hearts

The vitamin D(3) and nicotine (VDN) model is a model of isolated systolic hypertension (ISH) due to arterial calcification raising arterial stiffness and vascular impedance similar to an aged and stiffened arterial tree. We therefore analyzed the impact of this aging model on normal and diseased hearts with myocardial infarction (MI). Wistar rats were treated with VDN (n = 9), subjected to MI by coronary ligation (n = 10), or subjected to a combination of both MI and VDN treatment (VDN/MI, n = 14). A sham-treated group served as control (Ctrl, n = 10). Transthoracic echocardiography was performed every 2 wk, whereas invasive indexes were obtained at week 8 before death. Calcium, collagen, and protein contents were measured in the heart and the aorta. Systolic blood pressure, pulse pressure, thoracic aortic calcium, and end-systolic elastance as an index of myocardial contractility were highest in the aging model group compared with MI and Ctrl groups (P(VDN) < 0.05, 2-way ANOVA). Left ventricular wall stress and brain natriuretic peptide (P(VDNxMI) = not significant) were highest, while ejection fraction, stroke volume, and cardiac output were lowest in the combined group versus all other groups (P(VDNxMI) < 0.05). The combination of ISH due to this aging model and MI demonstrates significant alterations in cardiac function. This model mimics several clinical phenomena of cardiovascular aging and may thus serve to further study novel therapies.

Markers of vascular disease do not differ in black and white hemodialysis patients despite a different risk profile

Increased aortic stiffness, as measured by pulse wave velocity (PWV) and augmentation index (Aix), and vascular calcification have been associated with an unfavourable cardiovascular outcome in hemodialysis patients. However, the majority of data have been published in white patients and epidemiological data are discordant on the fate of patients of different races. In this cross sectional study we measured PWV and Aix by applanation tonometry and coronary artery and thoracic aorta calcium score (CAC and AoC) by electron beam tomography (EBT) in 81 Blacks and 61 Whites on maintenance hemodialysis. Vascular stiffness measurements and EBT scans were performed within a week of each other. There was no difference between races in age, systolic blood pressure or gender distribution. Blacks had a more frequent history of hypertension (100% versus 89%; P = 0.002), lower prevalence of dyslipidemia (30% versus 66%; P < 0.001), higher PTH levels (geometric mean 607 pg/ml versus 245 pg/ml; P = 0.039), received calcium based phosphate binders less frequently (37% versus 60%, P = 0.007) and calcium antagonists more frequently than Whites (54% versus 28%; P = 0.003). Nonetheless, the unadjusted and risk adjusted PWV and Aix, as well as CAC and AoC were not statistically different between races. In this dialysis cohort there was no difference in markers of vasculopathy between black and white patients despite differences in baseline clinical characteristics. Epidemiological data from the general population indicate that Blacks have lower calcium scores and stiffer vessels than Whites. Some studies in the renal populations suggest a better and others a similar survival of Blacks and Whites on hemodialysis. Our findings raise the important question of the prognostic significance of markers of vasculopathy in patients of different races and with different risk profiles.

Prevalence and Determinants of Coronary and Aortic Calcifications Assessed by Chest CT in Renal Transplant Recipients

Background: Coronary artery calcifications independently predict cardiovascular events (CVE) in the general population. We assessed the prevalence and determinants of coronary (CAC) and thoracic aorta (AoC) calcifications in renal transplant recipients (RTR). Methods: Consecutive RTR living in Belgium, with an isolated kidney graft functioning for more than 1 year, were asked to participate. They underwent a 16-slice spiral computerized tomography in order to measure calcium mass. Demographic, clinical, biochemical and urinary parameters were recorded. Results: We included 281 patients. CAC and AoC were detected in 81 and 85%, with geometric means (SD) of 52.2 (4.9) and 99.3 (8.2) mg, respectively. By multiple linear regression, independent predictors of both types of calcifications included older age, longer time on dialysis, a history of CVE, of multiple transplantations and of smoking. Other determinants of CAC were male gender, current statin use and history of parathyroidectomy, and other determinants of AoC included higher pulse pressure, shorter time under mycophenolate mofetil and current use of anti-vitamin-K. Conclusion: The prevalence of both CAC and AoC is substantial in RTR. We delineate independent determinants either common to both CAC and AoC or specific to one, and known as classic or chronic kidney disease related risk factors.

Association of pulse wave velocity with vascular and valvular calcification in hemodialysis patients

The recent Kidney Disease: Improving Quality Outcomes (KDIGO) recommendations called for an investigation of the relationship between various radiological methods to assess cardiovascular calcification and measures of arterial stiffness. Accordingly, in 131 adult maintenance hemodialysis patients, we investigated the association of aortic pulse wave velocity (PWV) with calcification of cardiac valves on echocardiography, coronary artery, and thoracic aorta calcium on computed tomography and a calcification score of the abdominal aorta obtained on a plain abdominal X-ray. All tests were performed within a week. Mean PWV increased as the severity of coronary artery, thoracic, and abdominal aorta calcium scores increased (each P<0.05). No trend was present for number of valves with calcification. After multivariable adjustment, abdominal aorta X-ray calcium scores remained associated with PWV (P=0.004), whereas the association of PWV with thoracic aorta and coronary artery calcium scores became marginal (P=0.308 and P=0.083, respectively). No association was found between number of calcified valves and PWV. This study demonstrates a strong association between abdominal aorta calcification on plain X-ray and PWV and a borderline association with thoracic aorta and coronary artery calcification. Sudden death and congestive heart failure, two frequent causes of death in hemodialysis, are likely caused by increased arterial stiffness that can be closely predicted by the presence of aortic calcification on plain X-rays.

Letter to the Editor

Calcifications are part of the development of atherosclerosis; they occur exclusively in atherosclerotic arteries and are absent in the normal vessel wall.1 Studies have demonstrated calcification in both coronaries and aortic arteries to be a specific marker of underlying atherosclerosis in the respective vascular beds.1 Extensive evidence exist that men are more likely to have calcification in the coronary arteries2,3; however, whether similar difference exists in other vascular beds is not well established. The purpose of this study is to evaluate whether the lower risk of atherosclerosis observed in coronary circulation in women compared with men is also observed in thoracic aorta. This is a cross-sectional study on a consecutive sample of 8549 asymptomatic individuals (69% men, mean age: 52±9 years) patients who presented to a single EBT scanning facility for CHD risk stratification.4 A history of cigarette smoking was considered present if a subject was a current or former smoker. Dyslipidemia was coded as present for any individual self-reporting a history of high total cholesterol, high LDL, low HDL, and/or high triglycerides, or current use of lipid-lowering therapy. Patients were considered to have diabetes if they reported using oral hypoglycemic agents, insulin sensitizers, or subcutaneous insulin and hypertension if they reported a history of high blood pressure or used antihypertensive medications. A family history of CHD was considered premature if the immediate family (parents or siblings) experienced a fatal or nonfatal myocardial infarction before age of 55 years. Individuals …

Determinants of coronary artery and aortic calcification in the Old Order Amish.

Coronary artery calcification (CAC) is associated with an increased risk of cardiovascular disease; little is known, however, about thoracic aortic calcification (AC). Our goal was to characterize risk factors for CAC and AC and to estimate the genetic contribution to their variation. The presence and quantity of CAC and AC were measured with electron beam computed tomography and fasting blood tests and cardiovascular risk factors were obtained in 614 asymptomatic Amish subjects. CAC prevalence was higher in men than women (55% versus 41%; P<0.0001), although there was no sex difference in AC prevalence (51% and 56% in men and women, respectively; P=0.95). Age was more strongly associated with AC presence (odds ratio [OR], 2.7 for 5 years) than CAC presence (OR, 1.9 for 5 years) (homogeneity P=0.001). Subjects with AC had a 3.3-fold higher odds of having CAC. Heritabilities of CAC and AC presence were 0.27+/-0.17 (P=0.04) and 0.55+/-0.18 (P=0.0008), respectively, whereas the heritabilities of quantity of CAC and AC were 0.30+/-0.10 (P=0.001) and 0.40+/-0.10 (P<0.0001), respectively. The genetic correlation between CAC and AC quantity was 0.34+/-0.19, whereas the environmental correlation between these 2 traits was 0.38+/-0.09. CAC and AC have similar risk factors, except male gender is associated only with CAC and age is more strongly associated with AC. The patterns of correlations suggest that CAC and AC share some common sets of genes and environmental factors, although it is likely that separate genes and environmental factors also influence calcification at each site.

Prevention of aortic calcification by etidronate in the renal failure rat model

Our recent clinical study indicated that etidronate may inhibit the progression of aortic calcification in hemodialysis patients. To determine whether etidronate inhibits aortic calcification in renal failure rats, renal failure was induced by subtotal nephrectomy, in which 5/6 of the kidneys were removed. Significant increases in serum creatinine levels were observed 2 weeks after the operation, at which point treatment with etidronate and calcitriol was initiated. Etidronate at 5 or 10 mg/kg significantly reduced the thoracic and abdominal aortic calcification induced by calcitriol. It also reduced the dysfunction in aortic contraction. The elevation of bone metabolism and reduction of bone mineral density observed in the nephrectomized rats were not affected by treatment with 5 mg/kg etidronate. No changes in serum Ca and the product of Ca and P levels were observed between the non etidronate-treated group and the 5 mg/kg etidronate-treated group. Moreover, the reduction in the aortic expression of matrix Gla protein mRNA observed in nephrectomized rats was reversed by 5 mg/kg etidronate. These results show that etidronate at concentrations that do not affect the bone mineral density inhibits aortic calcification and recovers vascular dysfunction in renal failure rats.

Assessment by Cardiovascular Magnetic Resonance, Electron Beam Computed Tomography, and Carotid Ultrasonography of the Distribution of Subclinical Atherosclerosis Across Framingham Risk Strata

Screening for subclinical atherosclerosis has been advocated for individuals at intermediate global risk for coronary heart disease (CHD). However, the distribution of subclinical atherosclerosis test values across CHD risk strata is unknown. We studied a stratified random sample of 292 participants (mean age 59.5 years, 50% women) from the offspring cohort of the Framingham Heart Study who were free of clinically apparent cardiovascular disease. We assessed abdominal and thoracic aortic plaque burden by cardiovascular magnetic resonance (CMR), coronary artery calcification (CAC) and thoracic aortic calcification (TAC) by electron beam computed tomography, and common carotid intima-media thickness (C-IMT) by ultrasonography. We categorized the upper 20% of each measurement as a high level of atherosclerosis and evaluated these variables across clinically relevant Framingham CHD risk score strata (low, intermediate, and high risk). In age-adjusted analyses in men and women, correlations across CMR aortic plaque, CAC, TAC, and C-IMT were low (maximum r = 0.30 for CAC:TAC in women, p <0.005). In men and women, the proportion of subjects with high atherosclerosis test results for any of these measurements increased significantly across Framingham CHD risk score strata (Kruskal-Wallis test, p <0.0001). In the intermediate Framingham CHD risk score category, 14% of men and 25% of women had a high atherosclerosis result on >or=2 measurements. However, different participants were identified as having high atherosclerosis by each modality. For example, in a comparison of the overlap across CMR aortic plaque, CAC, and C-IMT, only 4% of men and 16% of women were classified as having high atherosclerosis on all 3 measurements. In conclusion, in a community-based sample, correlations among subclinical atherosclerosis test results are low, and a substantial proportion has high levels of subclinical atherosclerosis detected on >or=2 imaging tests.

The relationship between four single nucleotide polymorphisms in the promoter region of the osteoprotegerin gene and aortic calcification or coronary artery disease in Koreans

Osteoprotegerin (OPG) is a recently identified cytokine that acts as a decoy receptor for the receptor activator of the NF-kappaB ligand (RANKL). OPG has been shown to be an important inhibitor of osteoclastogenesis and arterial calcification in animal models. OPG has been proposed as a link molecule between osteoporosis and arterial calcification, but the relationship between the OPG gene and the cardiovascular system in human populations is unclear. Thus, the aim of this study was to investigate the relationship between OPG gene polymorphisms and aortic calcification or coronary artery disease in Koreans. Genotyping of four polymorphisms, A163G, G209A, T245G and T950C, in the promoter region of the OPG gene was performed in 251 healthy Korean women (mean age 51.3 +/- 6.9 years) and in a second study population consisting of 100 patients who underwent coronary angiography (mean age 57.0 +/- 11.9 years), by allelic discrimination using the 5' nuclease polymerase chain reaction assay. Cardiovascular risk factors and serum OPG levels were measured and aortic calcification in thoracic and abdominal aorta was examined by simple radiological methods. In the first study population, the prevalence of aortic calcification increased significantly as the subjects grew older. The frequencies of mutant alleles were significantly higher in the subjects with aortic calcification compared with those without aortic calcification in G209A and T950C polymorphisms, although these significances were lost after adjustment for age. No significant relationship was found between OPG gene polymorphisms and serum OPG levels or cardiovascular risk factors. In the second study group, there were no associations between OPG promoter genotypes and aortic calcification, serum OPG levels, or coronary artery disease. We observed that the four polymorphisms in the promoter region of the OPG gene were not associated with aortic calcification or coronary artery disease in Koreans. Further studies are needed to clarify this relationship.

Comparison of Atherosclerotic Calcification Burden in Persons With the Cardiometabolic Syndrome and Diabetes

The cardiometabolic syndrome (CMS) and diabetes are associated with higher cardiovascular risk. The authors compared the association of CMS risk factors and diabetes with coronary and aortic calcium. A total of 4468 adults (42% female) underwent computed tomography for determination of coronary artery calcium (CAC) and thoracic aortic calcium (TAC) and were classified according to the presence of diabetes mellitus (DM) and number of CMS risk factors. The prevalence of CAC ranged from 51% in men and 35% in women with neither DM nor CMS to 75% in men and 58% in women with both DM and CMS, whereas TAC ranged from 29% to 44% in men and 36% to 55% in women. Women with four or five CMS risk factors more often had CAC (53%) and TAC (51%) than those with DM without CMS (40% and 35%, respectively) (p<0.001 across all disease groups). Adjusted odds (and 95% confidence intervals) of CAC for those with three CMS risk factors, four CMS risk factors, DM without CMS, and DM with CMS vs. those without CMS were 1.14 (0.93-1.39), 1.46 (1.12-1.90), 1.59 (1.06-2.38), and 2.10 (1.52-2.90) for CAC and 1.14 (0.91-1.42), 1.03 (0.77-1.37), 1.03 (0.68-1.54), and 1.41 (1.03-1.92) for TAC. Multiple CMS risk factors are associated with increased CAC, but not TAC; DM with CMS has the highest prevalence of CAC and TAC.

Effect of Etidronate on Aortic Calcification and Bone Metabolism in Calcitoriol-Treated Rats With Subtotal Nephrectomy

The present study was undertaken to determine the effects of etidronate (ED) on calcitriol-induced aortic calcification and bone metabolism in rats with renal failure. Severe aortic calcification was induced by treatment with calcitriol for 3 weeks in rats in which 5/6 of the kidneys were removed (SNx group). Treatment of ED (10 mg/kg) together with calcitriol after subtotal nephrectomy (SNx) significantly inhibited thoracic and abdominal aortic calcification 3 weeks after the operation; however, ED (2 mg/kg) was ineffective. The serum levels of osteocalcin and pyridinoline decreased in ED (10 mg/kg) treated-renal failure rats compared with SNx rats. Total bone mineral density (BMD) in the SNx group was lower than that in the sham group, in which animals were treated with calcitriol after a sham operation. The total BMD value in the ED (10 mg/kg)-treated group was similar to that in the SNx group, whereas the levels of cancellous BMD were low in the ED (10 mg/kg)-treated rats. Our data show that ED at a dosage that suppresses bone metabolism markedly inhibits vascular calcification in rats with renal failure.

The Role of Valvular and Thoracic Aortic Calcifications in Distinction Between Ischemic and Nonischemic Cardiomyopathy

Determination of underlying etiology in patients with dilated and globally hypokinetic left ventricles may sometimes be difficult even after detailed history and complete clinical evaluation. Cardiac valvular and thoracic aortic calcifications have previously been reported to be used as a window to diffuse atherosclerosis of the vascular system. The authors prospectively examined the predictive value of mitral annular calcification (MAC), aortic valve calcification (AVC), and thoracic aortic calcification (TAC) in diagnosis of coronary artery disease as the underlying cause of diffuse left ventricular dilatation and systolic dysfunction. The study included 98 consecutive patients (male/female = 76/22, mean age = 58.9 +/- 10.7 years, range: 33 to 75 years) over the age of 30 years admitted to their clinics between October 1999 and December 2001 with signs and symptoms of congestive heart failure associated with documented cardiomegaly. Transthoracic echocardiography and coronary angiography were performed in all patients for the evaluation of valvular calcifications and coronary status. Although there was no significant difference between the groups with and without coronary artery stenosis (CAS), with regard to presence of MAC, patients with CAS tended to have MAC more frequently (12/61, 20% vs 4/37, 11%, p > 0.05). AVC and TAC were found to be significantly more frequent in patients with CAS compared to those without CAS (AVC, 35/61, 57% vs 4/37, 11%, p < 0.001 and TAC, 28/61, 46% vs 2/37, 5%, p < 0.001). While all 3 calcifications had sensitivity under 60%, and specificity and positive predictive value over 75% individually, the presence of any of them had a sensitivity of 80%, specificity of 86%, positive predictive value of 91%, and negative predictive value of 73%. Thus the presence of any of these calcifications distinguished patients with coronary artery disease with a sensitivity of 80% and specificity of 86%. The presence of aortic valvular valve and thoracic aortic calcifications seems to be associated with significant coronary arterial stenosis; however, with relatively low negative predictive values these cannot be used in clinical practice for diagnosis of underlying coronary artery disease in patients with dilated left ventricles and impaired systolic functions.

Epidemiology and association of vascular and valvular calcium quantified by multidetector computed tomography in elderly asymptomatic subjects

The epidemiology of and association between vascular and valvular calcium as quantified by multidetector computed tomography (MDCT) were studied in 416 elderly subjects with no history of coronary artery disease. Coronary calcium (CC), descending thoracic aortic calcium (DTAC), aortic valve calcium (AVC), and mitral valve calcium (MVC) were present in 282 (68%), 214 (51%), 152 (37%), and 68 (16%) subjects, respectively. Multiple logistic regression analysis showed that after adjusting for age and gender, subjects with AVC (odds ratio [OR] 2.3), MVC (OR 2.81), and DTAC (OR 2.79) were independently and significantly more likely to have CC. Further evidence is provided for the notion that calcifications in those regions are associated and that MDCT can be used as a tool for the global assessment of vascular and valvular calcium.

Spiral computed tomography evidence of close correlation between coronary and thoracic aorta calcifications

Coronary calcium (CC) is invariably associated with coronary atherosclerosis and can be diagnosed noninvasively by fast spiral computed tomography (dual slice mode) (CT). Calcium is often deposited in the aorta as well, but the pathogenesis, correlates and clinical implications of calcification of the aorta are not yet elucidated. A possible association between the presence of CC and thoracic aorta calcification, as detected by spiral CT, has not been investigated yet. The goal of the present work was to examine by spiral CT whether an association exists between the presence of CC and thoracic aorta calcification in patients with high risk for atherosclerotic development. Four hundred and five patients with at least two risk factors for atherosclerosis were included (212 men and 193 women, age ranged 52–79 years). All underwent chest CT for CC and aortic calcification scoring. Calcifications’ thickness of ≥5 mm was considered advanced. CC was documented in 294 patients (170 men, 124 women; mean age 66 ± 6 years, range 55–78 years). The non-CC group (control) included 111 patients (42 men, 69 women; mean age 64 ± 6 years, range 52–79 years). Significant differences were found between CC group and control for the presence of ascending aorta calcification (69% versus 36%, P < 0.001), and advanced calcification of ≥5 mm (17% versus 4%, P < 0.001). Significant differences were also found between groups regarding the presence of descending aorta calcification (60% versus 38%, P < 0.001), and number of consecutive slices with calcification (18.8 ± 12.4 versus 10.7 ± 8.7, P < 0.01). We identified age (in decades) (OR 1.9, 95% CI 1. 2–3.0, P < 0.001), gender (female) (OR 0.4, 95% CI 0.2–0.6, P < 0.001), and thoracic aorta calcification (OR 2.9, 95% CI 1.7–5.0, P < 0.001) as the independent variables significantly associated with CC. Only age [odds ratio (OR) 3.05, 95% confidence interval (CI) 1.86–5.01, P < 0.001] and CC (OR 2.53, 95% CI 1.26–5.08, P = 0.006) were identified as independent variables for the prediction of thoracic aorta calcification. Conclusions: Our study demonstrated a strong association of CC and calcification of the thoracic aorta on spiral CT.

Association of aortic valve calcium detected by electron beam computed tomography with echocardiographic aortic valve disease and with calcium deposits in the coronary arteries and thoracic aorta

We conducted electron beam computed tomographic (EBCT) testing in a representative sample of 327 Framingham Heart Study subjects without clinical cardiovascular disease. EBCT was compared with 2-dimensional echocardiography for the detection of degenerative aortic valve (AV) disease. We determined the association between EBCT measures of AV calcium and calcium deposits in the coronary arteries and thoracic aorta. Of 327 subjects (mean age 60 ± 9 years; 51% men), 14% had EBCT AV calcium (median Agatston score 0, range 0 to 1,592). The prevalence of AV calcium increased predictably across decades of age. Compared with echocardiography, the sensitivity and specificity of EBCT for the detection of degenerative AV disease were 24% and 94%, respectively. In unadjusted logistic regression models, the prevalence of EBCT AV calcium increased across tertiles of coronary artery calcium (for trend across tertiles, odds ratio [OR] 2.2, 95% confidence interval [CI] 1.4 to 3.5) and thoracic aorta calcium (for trend OR 2.8, 95% CI 1.7 to 4.4). After adjustment for age and gender, the associations of AV calcium with coronary calcium and thoracic aorta calcium were attenuated and no longer statistically significant. Thus, compared with echocardiography, EBCT was specific but insensitive for the detection of degenerative AV disease. EBCT AV calcium was associated with calcium deposits in the coronary arteries and the thoracic aorta, but these associations were confounded by age and risk factors.

Relation of thoracic aortic and aortic valve calcium to coronary artery calcium and risk assessment

Aortic calcium, aortic valve calcium (AVC), and coronary artery calcium (CAC) have been associated with cardiovascular event risk. We examined the prevalence of thoracic aortic calcium (TAC) and AVC in relation to the presence and extent of CAC, cardiovascular risk factors, and estimated risk of coronary heart disease (CHD). In 2,740 persons without known CHD aged 20 to 79 years, CAC was assessed by electron beam- or multidetector-computed tomography. We determined the prevalence of TAC and AVC in relation to CAC, CHD risk factors, and predicted 10-year risk of CHD. A close correspondence of TAC and AVC was observed with CAC. TAC and AVC increased with age; by the eighth decade of life, the prevalence of TAC was similar to that of CAC (>80%), and 36% of men and 24% of women had AVC. Age, male gender, and low-density lipoprotein cholesterol were directly related to the likelihood of CAC, TAC, and AVC; higher diastolic blood pressure and cigarette smoking additionally predicted CAC. Body mass index and higher systolic and lower diastolic blood pressures were also related to TAC, and higher body mass index and lower diastolic blood pressure were related to AVC. Calculated risk of CHD increased with the presence of AVC and TAC across levels of CAC. TAC and AVC provided incremental value over CAC in association with the 10-year calculated risk of CHD. If longitudinal studies show an incremental value of aortic and aortic valve calcium over that of CAC for prediction of cardiovascular events, future guidelines for risk assessment incorporating CAC assessment may additionally incorporate the measurement of aortic and/or aortic valve calcium.