Prognostic Value of Aortic and Mitral Valve Calcium Detected by Contrast Cardiac Computed Tomography Angiography in Patients With Suspicion of Coronary Artery Disease

Aortic valve calcium (VC) detected on noncontrast cardiac computed tomography angiography (CCTA) is known to be associated with all-cause mortality in asymptomatic and primary prevention population. However, the clinical significance of aortic and mitral VC remains unknown in symptomatic patients with suspected coronary artery disease (CAD). The aim of the present study was to assess whether aortic and mitral VC is independently associated with cardiac events and all-cause mortality in symptomatic patients with suspected CAD. A total of 369 symptomatic patients (mean age 55 ± 11 years, 60% men) who were referred for CCTA because of suspected CAD were included in the study. Aortic and mitral VC was detected and quantified by volume on contrast CCTA. Median follow-up for events (coronary events and all-cause mortality) was 2.8 (interquartile range 1.6 to 4.0) with a maximum of 5.5 years. A total of 39 patients (11%) had VC. Increased age, hypertension, and increased Agatston coronary artery calcium score were associated with VC. During the follow-up, patients with VC had higher risk for a coronary event (38.8% vs 11%, log-rank p <0.001) and worse survival rate (92.3% vs 99.1%, log-rank p = 0.002) compared with those without VC. Volume of VC was independently associated with outcome after adjusting for clinical variables (hazard ratio 1.88, p <0.001), Agatston coronary artery calcium score (hazard ratio 1.47, p = 0.03), and significant CAD (hazard ratio 1.81, p = 0.001). In conclusion, aortic and mitral VC volume quantified on contrast CCTA was independently associated with coronary events and all-cause mortality in patients with suspected CAD.