Abstract 11650: Echocardiographic Multiple Calcium Deposits in Heart Valves and Aortic Root as a Marker of the Extent and Vulnerable Characteristics of Coronary Artery Plaque

Abstract

Background: Aortic valve and root calcification (AVC, ARC) and mitral annular calcification (MAC) are sought to be a sign of aortosclerosis including coronary arteries. However, the clinical significance of these calcium deposits on coronary artery plaque has not been fully elucidated. Thus, we examined the hypothesis that echocardiographic multiple calcium deposits in heart valves and aortic root could infer a higher risk of coronary artery disease (CAD).

Methods: We enrolled 565 patients (age: 65 ± 10 years, 63% men) with low-intermediate Framingham 10-year risk (≤ 20%) who underwent 64-multidetector computed tomography and transthoracic echocardiography within 1 week. Patients with prior CAD (myocardial infarction, coronary revascularization, and regional wall motion abnormality) were excluded. 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: Compare with no or one calcium deposit and no or one coronary risk factor, patients with multiple calcium deposits with multiple coronary risk factors (n = 113) had a higher prevalence of obstructive CAD (13 vs. 71%, p < 0.001) and that of VP (8 vs. 46%, p < 0.001), and a greater extent of CAP (1.3 ± 2.1 vs. 5.2 ± 3.0 segments, p < 0.001) and MCAP (0.4 ± 0.9 vs. 2.1 ± 1.9 segments, p < 0.001), but not NCAP (p = 0.09). After adjustment for age, gender, traditional risk factors, and medications, multiple calcium deposits remained as an independent predictor for the presence of obstructive CAD (OR [95%CI] 4.53 [2.89 - 7.11], p < 0.001) and that of VP (2.98 [1.84 - 4.82], p < 0.001). In addition, it was independently correlated with the segment number of CAP (β-estimate [95%CI] 2.30 [1.81 - 2.79], p < 0.001) and MCAP (0.82 [0.55 - 1.09], p < 0.001), but not NCAP (p = 0.24).

Conclusion: The combined presence of AVC, ARC, and MAC is highly associated with the extent and vulnerable characteristics of coronary plaque in patients with low-intermediate Framingham 10-year risk.