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(Circulation. 2008;118:1328-1334.)
© 2008 American Heart Association, Inc.

Imaging

Calcification of the Thoracic Aorta as Detected by Spiral Computed Tomography Among Stable Angina Pectoris Patients

Association With Cardiovascular Events and Death

Alon Eisen, MD; Alexander Tenenbaum, MD; Nira Koren-Morag, PhD; David Tanne, MD; Joseph Shemesh, MD; Massimo Imazio, MD; Enrique Z. Fisman, MD; Michael Motro, MD; Ehud Schwammenthal, MD; Yehuda Adler, MD

From the Cardiac Rehabilitation Institute (A.E., A.T., N.K.-M., J.S., E.Z.F., M.M., E.S., Y.A.) and Stroke Center, Department of Neurology (D.T.), Chaim Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, and Cardiology Department (M.I.), Maria Vittoria Hospital, Torino, Italy.

Correspondence to Yehuda Adler, MD, Cardiac Rehabilitation Institute, Talpiot Medical Leadership Program, Chaim Sheba Medical Center, 52621 Tel-Hashomer, Israel. E-mail adlery{at}post.tau.ac.il

Received May 14, 2007; accepted July 9, 2008.

Background— Calcification of the thoracic aorta is associated with atherosclerotic risk factors, yet its pathogenesis and clinical implications are not yet elucidated. The goal of the present study was to assess whether thoracic aorta calcification is associated with an increased risk of cardiovascular events and death in patients with stable angina pectoris.

Methods and Results— A prospective cohort of 361 stable angina pectoris patients (307 men, 54 women; age range, 37 to 83 years) underwent chest spiral computed tomography and were evaluated for aortic calcification. We recorded the incidence of cardiovascular events and death during a 4.5- to 6-year follow-up. Aortic calcification was documented in 253 patients (70% of patients; 213 men, 40 women). Patients with aortic calcification were older (mean age, 65±7 versus 55±9 years; P<0.001), and fewer were classified as smokers (13% versus 26%; P=0.014) compared with patients without aortic calcification. Significant correlation was found between patients with and those without aortic calcification for the presence of aortic valve calcification (28% versus 11%; P<0.001), mitral annulus calcification (29% versus 4%; P<0.001), and coronary calcification as expressed by coronary calcium score. (P<0.001). During 4.5 to 6 years of follow-up, 19 patients died, all of whom were in the aortic calcification group. Age-adjusted hazard ratios for total events and cardiovascular events by aortic calcification were 2.84 (95% CI, 1.52 to 5.30; P=0.001) and 2.70 (95% CI, 1.33 to 5.47; P=0.006), respectively. In multivariable analysis, hazard ratios for total events and cardiovascular events were 2.79 (95% CI, 1.46 to 5.20; P=0.002) and 4.65 (95% CI, 1.19 to 18.26; P=0.028), respectively.

Conclusions— Calcification of the thoracic aorta is age related and associated with coronary calcification and valvular calcification. Thoracic aortic calcification is associated with an increased risk of death and cardiovascular disease.

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CLINICAL PERSPECTIVE

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Clinical Summaries
Circulation 2008 118: 1307-1308. [Extract] [Full Text]

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