Prognostic role of cardiac calcifications in primary prevention: A powerful marker of adverse outcome highly dependent on underlying cardiac rhythm

• Published in: International journal of cardiology Vol. 258; pp. 262 - 268
• Main Authors: Mazzone, Carmine, Cioffi, Gianni, Di Nora, Concetta, Barbati, Giulia, Guidetti, Federica, Faggiano, Pompilio, Gaibazzi, Nicola, Faganello, Giorgio, Borca, Endria Casanova, Di Lenarda, Andrea
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.05.2018
• Subjects: Atrial fibrillation; Calcium score; Echocardiography; Mitral annulus calcification; Primary prevention; Valve calcification; Mitral annulus calcification; Calcium score; PACS; FRS; LVEF; LV; DT; SD; SIEC; TDI; CKD-EPI; CKD; SR; eGFR; Echocardiography; CAC; AF; AOC_MAC; Atrial fibrillation; CAD; ECG; ICD; IQR; CVD; EACVI; CT; CV; Primary prevention; CCV; DRG; Valve calcification; CHD
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2018.01.101

Increasing evidence exists regarding calcium detected in aortic cusps and/or mitral annulus (AOC_MAC) at transthoracic echocardiogram as a predictor of cardiovascular (CV) events and mortality. To verify whether AOC_MAC has a prognostic role in the setting of primary prevention independently of the presence of atrial fibrillation (AF). All subjects consecutively referred from January 2011 to October 2014 to the Cardiovascular Centre for CV risk assessment in primary prevention were selected. AOC_MAC was assessed by transthoracic echocardiography. Primary study endpoint was a composite of CV hospitalizations/all-cause death. The 1389 study patients were 70 years old, 43% males, 24% had diabetes mellitus, 75% arterial hypertension, 56% dyslipidaemia. Of all, 997 (72%) were in sinus rhythm (SR), 392 (28%) in AF. Patients with AF were older and more frequently males, with larger atria than SR subjects. During a median follow-up of 32 months, 165 patients (12%) were hospitalized for CV cause, 68 (5%) died. The primary endpoint occurred more frequently in patients with than without AOC_MAC (18% vs 11%, p < 0.001). AF patients showed higher event-rate compared with patients in SR (20% vs 10%, respectively; p < 0.01). AOC_MAC emerged as an independent prognosticator of primary endpoint in SR patients (HR 1.74 [1.07–2.82], p = 0.02), together with increasing age and left ventricular hypertrophy, while AOC_MAC had no prognostic relevance in AF patients. In subjects with multiple CV risk factors assessed in primary prevention, the presence of AF nullifies the prognostic power of AOC_MAC, on the contrary robustly confirmed in SR patients. •Calcium detected in aortic cusps and/or mitral annulus would be a predictor of CV events.•Retrospective cohort study of 1389 from 10,225 subjects in primary prevention•To verify whether AOC_MAC has a prognostic role independently of atrial fibrillation.•The AOC_MAC emerged as an independent prognosticator of primary endpoint in sinus rhythm.•The presence of atrial fibrillation nullifies the prognostic power of AOC_MAC.