Non-stenotic aortic valve fibro-calcific content association with clinical outcomes in coronary artery disease patients

Background Aortic stenosis (AS) is the most common valve disorder, characterized by fibro-calcific remodeling of valve leaflets, which occurs even before hemodynamic changes. Progressive aortic valve calcification (AVC) leads to worse cardiovascular outcomes. However, the fibrotic component (AVF) of non-stenotic aortic valve leaflets and its role in negative outcomes have not yet been explored. Purpose To evaluate whether fibro-calcific content of aortic valve can be a predictor of outcomes in high risk CAD patients without AS. Methods We included 203 coronary artery disease (CAD) high-risk patients without AS who underwent cardiac contrast-enhanced computed tomography (CT). The calcium and fibrosis volumes were indexed by dividing the volume by the aortic annular area. The composite outcome, including all-cause mortality, cardiovascular mortality, acute heart failure, and re-infarction, was assessed at 5-year follow-up. Results The mean age of our cohort was 68.4±10 years, 24% had diabetes, 72% had dyslipidemia, 65% had hypertension, and 58% were former or current smokers. CT quantifications were as follows: AVC 51.6±94.8 mm3/cm2 and AVF 231.3±148.7 mm3/cm2. After 5 years of follow-up, 40 (23%) events occurred, where patients with AVC above the median (9.88[0-58.1] mm3/cm2) or AVC>0 were associated with an increased risk of adverse events (all p<0.05). The AVF component did not show any influence on negative outcomes in these patients. Conclusion AVC, but not AVF, assessed in CAD high-risk patients without AS, predicts the worst outcome. Our results on valvular fibrosis could be altered by treatments in secondary prevention. Studies in a population without pharmacological influence are needed to better understand the effect of AVF on the development and progression of valve pathology as well as outcomes.