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Aortic valve and aortic root calcifications for predicting major adverse cardiovascular events: NADESICO study

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Abstract

To assess aortic valve calcification (AVC) and aortic root calcification (ARC) and to examine their usefulness for predicting major adverse cardiovascular events (MACE). This multicenter prospective cohort study recruited 1187 patients suspected of coronary artery disease (CAD) who underwent coronary computed tomography. MACE included cardiovascular death, myocardial infarction, stroke, revascularization and hospitalization for unstable angina, heart failure or aortic disease. Cox proportional hazard model and C-statistic were used to assess mutual associations between Framingham risk score, coronary artery calcification (CAC) and AVC or ARC with incident MACE. A total of 980 patients (mean age, 65 ± 7 years; female, 45.8%) with assessment of AVC and ARC Agatston scores were analyzed. Among them, 86 developed MACE during a median follow-up of 4.04 years. Cox proportional hazard analyses showed that the presence or severity of AVC and ARC was significantly associated with MACE development after adjusting the CAC Agatston score. Compared with the model of Framingham risk score alone, C-statistics of the model adding AVC or ARC Agatston score to Framingham risk score increased (ΔC-statistic; + 0.013 or + 0.032, respectively). However, they were not superior to the model adding CAC Agatston (ΔC-statistic; − 0.077 and − 0.058, respectively). AVC or ARC on the top of CAC was a predictive factor for increased MACE in patients with suspected CAD. However, an additional model of AVC or ARC score to Framingham risk score was not as effective as that of CAC Agatston score.

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Abbreviations

ARC:

Aortic root calcification

AVC:

Aortic valve calcification

AS:

Aortic stenosis

BMI:

Body mass index

BP:

Blood pressure

CAC:

Coronary artery calcification

CAD:

Coronary artery disease

CAS:

Coronary artery stenosis

CCT:

Cardiac computed tomography

CI:

Confidence interval

CVD:

Cardiovascular disease

eGFR:

Estimated glomerular filtration rate

FRS:

Framingham risk score

HR:

Hazard ratio

MACE:

Major adverse cardiovascular events

OR:

Odds ratio

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Acknowledgements

We would like to thank Drs. Masanao Naya (Hokkaido University Hospital, Sapporo, Japan), Masafumi Watanabe (Yamagata University Hospital, Yamagata, Japan), Tetsu Watanabe (Yamagata University Hospital, Yamagata, Japan), Satoshi Yasuda (Tohoku University Hospital, Sendai, Japan), Michihiro Yoshimura (Jikei University School of Medicine, Tokyo, Japan), Makoto Kawai (Jikei University School of Medicine, Tokyo, Japan), Tomonori Okamura (Keio University School of Meidicine, Tokyo, Japan), Hiroaki Naito (Nissei Hospital, Osaka, Japan), Masahiro Higashi (National Hospital Organization Osaka National Hospital, Osaka Japan), Hideaki Morita (Osaka medical College, Takatsuki, Japan), Kunihiro Nishimura (National Cerebral and Cardiovascular center, Suita, Japan), Yoko Nakao (National Cerebral and Cardiovascular Center, Suita, Japan), Yasuhide Asaumi (National Cerebral and Cardiovascular Center, Suita, Japan), Hiroyuki Miura (National Cerebral and Cardiovascular Center, Suita, Japan), Yutaka Furukawa (Kobe City Medical Center General Hospital, Kobe, Japan), Hiroyuki Tsutsui (Kyusyu University Hospital, Fukuoka, Japan), Tomohiro Kawasaki (Shin Koga Hospital, Kurume, Japan), Mitsuru Oishi (Kagoshima University Hospital, Kagoshima, Japan), Masaaki Miyata (Kagoshima University Hospital, Kagoshima Japan), Hitonobu Tomoike (NTT Research, Inc. MEI Lab, Tokyo, Japan), Junko Masue (National Cerebral and Cardiovascular Center, Suita, Japan), Yoko Sumita (National Cerebral and Cardiovascular Center, Suita, Japan), and Yusuke Sasahara (National Cerebral and Cardiovascular Center, Suita, Japan) for supporting NADESICO Study.

Funding

This research was supported by Japan Agency for Medical Research and Development under Grant Number 20gk0210026h001.

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Authors and Affiliations

  1. Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan

    Shinichi Wada, Yoshitaka Iwanaga, Michikazu Nakai & Yoshihiro Miyamoto

  2. Department of Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan

    Teruo Noguchi

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  1. Shinichi Wada
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  2. Yoshitaka Iwanaga
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  4. Yoshihiro Miyamoto
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Contributions

Study concept and design: SW, YI, and TN; data curation: SW and MN; analysis and interpretation of data: SW, MN, and YI; interpretation of results: YM and TN; supervision: YM and TN; writing–original draft: SW; writing–reviewing and editing: YI.

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Correspondence to Yoshitaka Iwanaga.

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Wada, S., Iwanaga, Y., Nakai, M. et al. Aortic valve and aortic root calcifications for predicting major adverse cardiovascular events: NADESICO study. Heart Vessels 38, 562–569 (2023). https://doi.org/10.1007/s00380-022-02187-9

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