Abstract 15141: Diffuse Calcium Deposits in Aortic Valve as a Marker of the Extent and Vulnerable Characteristics of Coronary Artery Plaque Assessed by 64-Multidetector Computed Tomography
Background: Aortic valve calcification (AVC) is considered a manifestation of atherosclerosis. However, the impact of diffuse calcium deposits in aortic valve on coronary atherosclerosis is unknown. We sought to examine the association of AVC position to the distribution and characteristics of coronary artery plaque using 64-multidetector computed tomography (MDCT).
Methods: We enrolled 563 patients (age: 66 ± 11 years, 66% men) with suspected coronary artery disease (CAD) referred for 64-MDCT. The presence and position of AVC were qualitatively assessed from both non-contrast and contrast CT datasets to characterize the calcium as either involving or sparing the annulus. Coronary arteries were assessed for the presence of obstructive CAD (> 50% lumen narrowing) and the segment number of calcified (CAP), mixed (MCAP), and noncalcified coronary atherosclerotic plaque (NCAP). Furthermore, the vulnerable plaque (VP) was defined as if three characteristics including low CT density (minimum CT density < 39 HU), positive remodeling, and adjacent spotty calcification were all present.
Results: The prevalence of detectable CAP, MCAP, and NCAP were 67%, 38%, and 52%, respectively. Patients with AVC involving the annulus (n = 213) had a higher prevalence of obstructive CAD (59 vs. 37 vs. 22%, p < 0.001) and that of VP (37 vs. 25 vs. 13%, p < 0.001), and a greater extent of CAP (4.7 ± 3.1 vs. 3.2 ± 3.1 vs. 1.9 ± 2.4 segments, p < 0.001), MCAP (1.9 ± 1.8 vs. 1.1 ± 1.5 vs. 0.7 ± 1.2 segments, p < 0.001), and NCAP (0.8 ± 1.3 vs. 0.8 ± 1.0 vs. 0.5 ± 0.8 segments, p = 0.001) compared to those with AVC sparing the annulus (n = 67) or those with no AVC (n = 283). After adjustment for age, gender, traditional risk factors, and medications, AVC involving the annulus remained as an independent predictor for the presence of obstructive CAD (OR [95%CI] 3.71 [2.32 - 5.93], p < 0.001) and that of VP (3.26 [1.94 - 5.49], p < 0.001). In addition, it was independently correlated with the segment number of CAP (β-estimate [95%CI] 1.92 [1.43 - 2.42], p < 0.001), MCAP (0.97 [0.71 - 1.24], p < 0.001), and NCAP (0.22 [0.02 - 0.42], p = 0.03).
Conclusion: </bold> Diffuse calcium deposits in aortic valve involving the annulus is highly associated with the extent and vulnerable characteristics of coronary plaque identified by 64-MDCT.
- © 2011 by American Heart Association, Inc.