Relationship Between Aortic Valve and Mitral Annular Calcification With Coronary Artery Calcification in Asymptomatic Individuals: Cross-Sectional and Longitudinal Analyses.

Abstract

Background: Aortic valve calcification (AVC), mitral annular calcification (MAC), and coronary artery calcification (CAC) all share common atherosclerotic origins. However, the relationship between these entities is not fully understood.

Methods: A total of 722 asymptomatic individuals who underwent health screening with serial cardiac computed tomography (CT) were retrospectively selected for analysis. AVC, MAC, and CAC were identified on CT, and the severity was quantified using Agatston units (AU). Multivariable regression models were used to identify the association between the severity of CAC and the probability of prevalent AVC and MAC, and the relation between annualized progression rates of AVC, MAC and CAC.

Results: On initial CT, the prevalence of AVC, MAC, and CAC was 11.4%, 6.5%, and 46.3%, respectively. Increasing baseline CAC severity was associated with a higher probability of both prevalent AVC (odds ratio [OR] per 100 AU increase, 1.03; 95% confidence interval [CI], 1.02-1.04; P < 0.001) and MAC (OR per 100 AU increase, 1.06; 95% CI, 1.05-1.07; P < 0.001), even after correction for other risk factors. On follow-up CT, the interval changes of MAC and CAC scores were also highly correlated (P < 0.001). However, no significant relationship was found between the interval changes of AVC and MAC scores, or between AVC and CAC.

Conclusion: We observed a close correlation between AVC, MAC, and CAC, which is in accord with their common atherosclerotic origin. However, the correlation between MAC and CAC progression but not with AVC suggests that other factors such as hemodynamics may have an important role in the further development of calcification.