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Aortic valve calcification predicts all-cause mortality independent of coronary calcification and severe stenosis

  • Author Footnotes
    1 Co-first authors.
    Jared L. Christensen
    Footnotes
    1 Co-first authors.
    Affiliations
    Department of Internal Medicine (Section of Cardiovascular Medicine), Providence VA Medical Center, Providence, RI, 02908, USA

    Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, 02903, USA
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  • Author Footnotes
    1 Co-first authors.
    Sydney Tan
    Footnotes
    1 Co-first authors.
    Affiliations
    Department of Internal Medicine (Section of Cardiovascular Medicine), Providence VA Medical Center, Providence, RI, 02908, USA

    Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, 02903, USA
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  • Hojune E. Chung
    Affiliations
    Department of Internal Medicine (Section of Cardiovascular Medicine), Providence VA Medical Center, Providence, RI, 02908, USA

    Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, 02903, USA
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  • Dhairyasheel S. Ghosalkar
    Affiliations
    Department of Internal Medicine (Section of Cardiovascular Medicine), Providence VA Medical Center, Providence, RI, 02908, USA

    Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, 02903, USA
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  • Reema Qureshi
    Affiliations
    Department of Internal Medicine (Section of Cardiovascular Medicine), Providence VA Medical Center, Providence, RI, 02908, USA

    Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, 02903, USA
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  • Alice Chu
    Affiliations
    Department of Internal Medicine (Section of Cardiovascular Medicine), Providence VA Medical Center, Providence, RI, 02908, USA

    Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, 02903, USA
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  • Wenzheng Yu
    Affiliations
    Department of Internal Medicine (Section of Cardiovascular Medicine), Providence VA Medical Center, Providence, RI, 02908, USA

    Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, 02903, USA
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  • Joshua Berus
    Affiliations
    Department of Internal Medicine (Section of Cardiovascular Medicine), Providence VA Medical Center, Providence, RI, 02908, USA

    Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, 02903, USA
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  • Nishant R. Shah
    Affiliations
    Department of Internal Medicine (Section of Cardiovascular Medicine), Providence VA Medical Center, Providence, RI, 02908, USA

    Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, 02903, USA
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  • Wen-Chih Wu
    Affiliations
    Department of Internal Medicine (Section of Cardiovascular Medicine), Providence VA Medical Center, Providence, RI, 02908, USA

    Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, 02903, USA
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  • Hyung Chun
    Affiliations
    Department of Medicine, Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT, 06520, USA
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  • Elena Aikawa
    Affiliations
    Department of Medicine, Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
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  • Gaurav Choudhary
    Affiliations
    Department of Internal Medicine (Section of Cardiovascular Medicine), Providence VA Medical Center, Providence, RI, 02908, USA

    Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, 02903, USA
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  • Alan R. Morrison
    Correspondence
    Corresponding author. Providence VA Medical Center, Research (151), 830 Chalkstone Avenue, Providence, RI, 02908, USA.
    Affiliations
    Department of Internal Medicine (Section of Cardiovascular Medicine), Providence VA Medical Center, Providence, RI, 02908, USA

    Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, 02903, USA
    Search for articles by this author
  • Author Footnotes
    1 Co-first authors.

      Highlights

      • Aortic valve calcification (AVC) is predictive of mortality after adjustment for cardiovascular risk, aortic stenosis (AS), and coronary artery calcification (CAC), in patients with history of smoking.
      • AVC is also predictive of nonfatal myocardial infarction and nonfatal cerebrovascular accident in this population.
      • There is prognostic value in reporting AVC from low dose lung cancer screening computed tomography.

      Abstract

      Background and aims

      Calcific aortic valve disease is highly prevalent in patients with significant smoking history and is a marker of atherosclerosis. The aim of this study was to define the prognostic value of aortic valve calcification (AVC) derived from low dose, lung cancer screening computed tomography (LCSCT) for all-cause mortality in this higher risk population.

      Methods

      This is a single site, retrospective analysis of 1529 moderate-to-high atherosclerotic cardiovascular risk U.S. veterans (65 years [IQI: 61, 68] years; 96% male), who underwent clinically indicated LCSCT. CTs were scored for aortic valve calcification (AVC) and coronary artery calcification (CAC). The primary endpoint was all-cause mortality and secondary endpoints were nonfatal myocardial infarction (MI) and nonfatal cerebrovascular accident (CVA).

      Results

      Over 4-year follow-up, 227 patients (15%) died, 112 patients (7%) had nonfatal MI, and 52 patients (3%) had nonfatal CVA. AVC was predictive of all-cause mortality (HR per 100: 1.041 [1.030–1.052], p < 0.001), and this association remained significant after multivariate adjustment for traditional atherosclerotic risk factors, including CAC (1.021 [1.007–1.036], p = 0.003). After excluding patients with severe aortic stenosis (AS) or severe AVC (≥1274 AU in women and ≥2065 AU in men), in a subset of 765 patients who had echocardiograms, this association remained significant after multivariate analysis (HR per 100: 1.052 [1.010–1.095], p = 0.014). Despite controlling for CAC in the models, AVC was still associated with MI (HR per 100: 1.021 [1.004–1.039], p = 0.017) and with CVA (HR per 100: 1.027 [1.002–1.051], p = 0.032).

      Conclusions

      Scoring AVC derived from LCSCT is predictive of mortality, nonfatal MI, and nonfatal CVA in patients at known risk for cardiovascular disease, independent of coronary calcification or severe aortic valve stenosis.

      Keywords

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