Association of aortic valve calcification to the presence, extent, and composition of coronary artery plaque burden: From the Rule Out Myocardial Infarction using Computer Assisted Tomography (ROMICAT) trial

Mahabadi, Amir A.; Bamberg, Fabian; Toepker, Michael; Schlett, Christopher L.; Rogers, Ian S.; Nagurney, John T.; Brady, Thomas J.; Hoffmann, Udo; Truong, Quynh A.

doi:10.1016/j.ahj.2009.07.027

« Previous Next »American Heart Journal
Volume 158, Issue 4 , Pages 562-568, October 2009

Association of aortic valve calcification to the presence, extent, and composition of coronary artery plaque burden: From the Rule Out Myocardial Infarction using Computer Assisted Tomography (ROMICAT) trial

Amir A. Mahabadi, BS
- Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA
Fabian Bamberg, MD, MPH
- Department of Clinical Radiology, Ludwig-Maximillians University, Klinikum Grosshadern, Munich, Germany
Michael Toepker, MD
- Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA
Christopher L. Schlett, BS
- Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA
Ian S. Rogers, MD, MBA, MPH
- Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
John T. Nagurney, MD, MPH
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
Thomas J. Brady, MD
- Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
Udo Hoffmann, MD, MPH
- Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
Quynh A. Truong, MD, MPH
- Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Reprint requests: Quynh A. Truong, MD, MPH, Cardiac MR PET CT Program, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA 02114.

Received 2 May 2009; accepted 24 July 2009.

Background

Aortic valve calcification (AVC) is associated with cardiovascular risk factors and coronary artery calcification. We sought to determine whether AVC is associated with the presence and extent of overall plaque burden, as well as to plaque composition (calcified, mixed, and noncalcified).

Methods

We examined 357 subjects (mean age 53 ± 12 years, 61% male) who underwent contrast-enhanced electrocardiogram-gated 64-slice multidetector computed tomography from the ROMICAT trial for the assessment of presence and extent of coronary plaque burden according to the 17-coronary segment model and presence of AVC.

Results

Patients with AVC (n = 37, 10%) were more likely than those without AVC (n = 320, 90%) to have coexisting presence of any coronary plaque (89% vs 46%, P < .001) and had a greater extent of coronary plaque burden (6.4 vs 1.8 segments, P < .001). Those with AVC had >3-fold increase odds of having any plaque (adjusted odds ratio [OR] 3.6, P = .047) and an increase of 2.5 segments of plaque (P < .001) as compared to those without AVC. When stratified by plaque composition, AVC was associated most with calcified plaque (OR 5.2, P = .004), then mixed plaque (OR 3.2, P = .02), but not with noncalcified plaque (P = .96).

Conclusion

Aortic valve calcification is associated with the presence and greater extent of coronary artery plaque burden and may be part of the later stages of the atherosclerosis process, as its relation is strongest with calcified plaque, less with mixed plaque, and nonsignificant with noncalcified plaque. If AVC is present, consideration for aggressive medical therapy may be warranted.