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. 2015 Jul 1:15:61.
doi: 10.1186/s12872-015-0058-5.

Additional value of associating aortic valve calcification to coronary calcium as a gatekeeper for coronary tomography angiography

Ana Faustino  1 , Rui Providência  2   3 , Luís Paiva  4 , Rui Catarino  5 , Susana Basso  6 , Marco Costa  7 , Lino Gonçalves  8   9
Affiliations

Additional value of associating aortic valve calcification to coronary calcium as a gatekeeper for coronary tomography angiography

Ana Faustino et al. BMC Cardiovasc Disord. .

Abstract

Background: Aortic valve calcification shares risk factors with coronary artery disease. Coronary calcium has been used has a gatekeeper to performing coronary tomography angiography. The aim of this study was to evaluate aortic valve calcification as a predictor of obstructive coronary artery disease by computed tomography, and its possible usefulness, alongside with coronary calcium, to improve the decision of whether or not to proceed with computed tomography angiography.

Methods: Transversal case-control study including 154 consecutive patients (62 ± 12 years, 57.6 % female, without known coronary or valve disease) undergoing calcium scoring and angiography through computed tomography (Phillips Brilliance, 16-slice). Predictors of aortic valve calcification and obstructive coronary artery disease were identified. Usefulness of aortic valve calcification when added to calcium score for prediction of obstructive coronary artery disease was assessed by binary logistic regression and net reclassification index.

Results: Aortic valve calcification was associated with higher coronary calcium, extent and prevalence of obstructive coronary disease, which was identified in 22.1 % of patients and was discriminated by aortic valve calcium with an area under curve 0.749 (p < 0.001, Youden index: 61). A higher discriminative power was achieved with a model based on coronary and aortic valve calcification (AUC 0.900, p < 0.001). Compared with calcium score >400 as a gatekeeper to angiography, the association of aortic calcium >61 allowed a net reclassification index of +7.7 % of patients.

Conclusions: Aortic valve calcification is associated with the prevalence and extent of obstructive coronary artery disease by computed tomography angiography and is an easy, fast and useful method to improve the selection of patients for angiography.

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Figures

Fig. 1
Fig. 1
ROC curves for the discrimination of obstructive coronary artery disease: AoVC – AUC 0.749, 95%CI 0.837-0.955, p < 0.001; CAC – AUC 0.896, 95%CI 0.837-0.955, p < 0.001; PM CAC + AoVC – AUC 0.900, 95%CI 0.838-0.962, p < 0.001; SCORE – AUC 0.690, 95%CI 0.577-0.802, p < 0.001; Framingham 0.596, 95%CI 0.471-0.721, p = 0.120. Legend: AoVC - aortic valve calcification; CAC - coronary artery calcium; CAD - coronary artery disease; PM CAC + AoVC: predictor model of obstructive CAD based on coronary artery calcium and aortic valve calcification
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