Usefulness of Echocardiographic Assessment of Cardiac and Ascending Aorta Calcific Deposits to Predict Coronary Artery Calcium and Presence and Severity of Obstructive Coronary Artery Disease

The presence of cardiac and aortic calcific deposits has been related to coronary artery disease (CAD) and cardiovascular events. The present study aimed to evaluate whether comprehensive echocardiographic assessment of cardiac and ascending aorta calcific deposits could predict coronary calcium and obstructive CAD. A total of 140 outpatients (age 61 ± 11 years; 90 men) without a history of CAD were studied. Aortic valve sclerosis and mitral annular, papillary muscle, and ascending aorta calcific deposits were assessed using echocardiography and semiquantified using an echocardiography-derived calcium score (ECS) ranging from 0 (no calcium visible) to 8 (severe calcific deposits). Coronary calcium scoring and noninvasive coronary angiography were performed using multislice computed tomography. Angiograms showing atherosclerosis were classified as having obstructive (≥50% luminal narrowing) CAD or not. The relation between ECS and multislice computed tomographic findings was explored using multivariate and receiver-operator characteristic curve analyses. Only ECS was associated with coronary calcium score >400 (odds ratio [OR] 3.6, 95% confidence interval [CI] 2.4 to 5.5, p <0.001). Similarly, only ECS (OR 1.8, 95% CI 1.4 to 2.4, p <0.001) and pretest likelihood of CAD (OR 1.7, 95% CI 1.0 to 2.8, p = 0.04) were associated with obstructive CAD. ECS ≥3 had high sensitivity and specificity in identifying patients with coronary calcium score >400 (87% for both) and obstructive CAD (74% and 82%, respectively). In conclusion, echocardiographic assessment of cardiac and ascending aorta calcium may allow detection of patients with extensive calcified coronary arterial atherosclerotic plaques.