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Echocardiographic calcification score in patients with low/intermediate cardiovascular risk

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Abstract

Purpose

Calcification of aortic valve and mitral annulus is associated with cardiovascular risk factors, morbidity and mortality. Assessment of cardiac calcification with echocardiography is feasible, however, only few structured scoring systems have been established so far with limited prognostic data. This study aimed to evaluate an echocardiographic calcification score (echo-CCS) in patients with low/intermediate cardiovascular risk.

Methods

Digitally stored echocardiography studies of 151 patients (median age 64, 49.7% male) from February 2008 to December 2009 were retrospectively reviewed for calcifications of the aortic valve, aortic root, mitral annulus, papillary muscles and ventricular septum. A calcification score ranging from 0 to 5 was assigned to every patient and its relation to computed tomography calcium score, coronary stenosis and ESC SCORE was assessed. Follow-up data were collected from 149 patients (98.7%) with a median of 6.2 years. Logistic regression and Kaplan–Meier analysis were performed to assess the association of the echo-CCS with significant coronary artery disease (≥ 50% stenosis) and risk for cardiac events and all-cause mortality.

Results

An association of the echo-CCS with the ESC SCORE (ρ = 0.5; p < 0.001) and a good correlation of the echo-CCS with the Agatston score (ρ = 0.73; p < 0.001) can be observed. Univariate regressions revealed that echo-CCS is a significant predictor for cardiac events [OR = 5.1 (CI: 1.7–15.0); p = 0.003], coronary intervention [OR = 2.8 (CI: 1.3–5.7); p = 0.006], hospitalisation for cardiac symptoms [OR = 2.0 (CI: 1.2–3.4); p = 0.007], all-cause mortality [OR = 2.6 (CI: 1.3–5.5); p = 0.01] and significant CAD [OR = 3.2 (CI: 1.9–5.4); p < 0.001].

Conclusions

We demonstrated the prevalence of an easily obtainable, radiation-free calcification score in patients with low/intermediate cardiovascular risk. The strong association with CT-calcium scoring may evoke its potential as an alternative method in CV risk assessment.

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Author notes

  1. Kristof Hirschberg and Manuel Reinhart contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany

    Kristof Hirschberg, Manuel Reinhart, Derliz Mereles, Florian André, Johannes Riffel, Marco Ochs & Hugo A. Katus

  2. Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany

    Lorenz Uhlmann

Authors
  1. Kristof Hirschberg
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  2. Manuel Reinhart
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  3. Derliz Mereles
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  4. Lorenz Uhlmann
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  5. Florian André
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  7. Marco Ochs
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Correspondence to Kristof Hirschberg.

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Hirschberg, K., Reinhart, M., Mereles, D. et al. Echocardiographic calcification score in patients with low/intermediate cardiovascular risk. Clin Res Cardiol 108, 194–202 (2019). https://doi.org/10.1007/s00392-018-1343-y

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  • DOI: https://doi.org/10.1007/s00392-018-1343-y

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