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. 2023 Mar;16(3):e014323.
doi: 10.1161/CIRCIMAGING.122.014323. Epub 2023 Mar 7.

Aortic Valve Calcium in Relation to Subclinical Cardiac Dysfunction and Risk of Heart Failure

Fang Zhu #  1 , Yannick Kaiser #  1   2 , Eric Boersma  3 , Daniel Bos  1   4 , Maryam Kavousi  1
Affiliations

Aortic Valve Calcium in Relation to Subclinical Cardiac Dysfunction and Risk of Heart Failure

Fang Zhu et al. Circ Cardiovasc Imaging. 2023 Mar.

Abstract

Background: The link between (mild) aortic valve calcium (AVC) with subclinical cardiac dysfunction and with risk of heart failure (HF) remains unclear. This research aims to determine the association of computed tomography-assessed AVC with echocardiographic measurements of cardiac dysfunction, and with HF in the general population.

Methods: We included 2348 participants of the Rotterdam Study cohort (mean age 68.5 years, 52% women), who had AVC measurement between 2003 and 2006, and without history of HF at baseline. Linear regression models were used to explore relationship between AVC and echocardiographic measures at baseline. Participants were followed until December 2016. Fine and Gray subdistribution hazard models were used to assess the association of AVC with incident HF, accounting for death as a competing risk.

Results: The presence of AVC or greater AVC were associated with larger mean left ventricular mass and larger mean left atrial size. In particular, AVC ≥800 showed a strong association (body surface area indexed left ventricular mass, β coefficient: 22.01; left atrium diameter, β coefficient: 0.17). During a median of 9.8 years follow-up, 182 incident HF cases were identified. After accounting for death events and adjusting for cardiovascular risk factors, one-unit larger log (AVC+1) was associated with a 10% increase in the subdistribution hazard of HF (subdistribution hazard ratio, 1.10 [95% CI, 1.03-1.18]), but the presence of AVC was not significantly associated with HF risk in fully adjusted models. Compared with the AVC=0, AVC between 300 and 799 (subdistribution hazard ratio, 2.36 [95% CI, 1.32-4.19]) and AVC ≥800 (subdistribution hazard ratio, 2.54 [95% CI, 1.31-4.90]) were associated with a high risk of HF.

Conclusions: Presence and high levels of AVC were associated with markers of left ventricular structure, independent of traditional cardiovascular risk factors. Larger computed tomography-assessed AVC is an indicative of increased risk for the development of HF.

Keywords: aortic valve calcium; cardiac computed tomography; cardiac dysfunction; heart failure; vascular calcification.

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Conflict of interest statement

None.

Figures

Figure 1.
Figure 1.
Flow chart of the study population. HF indicates heart failure.
Figure 2.
Figure 2.
Cumulative incidence curves for incident heart failure according to the aortic valve calcium categories. AVC indicates aortic valve calcium.
See this image and copyright information in PMC

Comment in

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