Published Online
on September 8, 2008

A more recent version of this article appeared on September 23, 2008

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Submitted on May 14, 2007
Accepted on July 9, 2008

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, and 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.

^* To whom correspondence should be addressed. E-mail: adlery{at}post.tau.ac.il.

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.

Key words: angina pectoris • aorta • atherosclerosis • calcification • computed tomography

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

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