Association between coronary artery calcium and the progression of calcific aortic valve disease: a hospital population-based observational retrospective cohort study

OBJECTIVES: To explore the association between the degree of coronary artery calcium (CAC) and the progression of calcific aortic valve disease (CAVD). DESIGN: A single-centre retrospective cohort study using a hospital-based database. PARTICIPANTS: A total of 2898 patients who underwent coronary CT angiography and serial echocardiograms at ≥6 months apart were included. Initial echocardiography was performed within 6 months from the time of CCTA. OUTCOME MEASURES: CAC was divided into four groups: 0, 1-99, 100-399 and ≥400 (Agatston units, AU). The progression of CAVD was defined in two ways: progression 1 as at least one grade of progression, progression 2 as at least moderate aortic stenosis (AS) at follow-up. RESULTS: At the initial CAVD grade, patients with at least mild AS tended to increase with increasing CAC (p<0.001). During a median follow-up of 3.2 years (IQR, 1.8-5.0 years), 101 patients (3.5%) experienced progression 1 and 24 patients (0.8%) suffered progression 2. There was a statistically significant increase in risk of progression 1 in CAC 100-399 and ≥400 groups than CAC 0 and 1-99 groups (p<0.001). In progression 2, the CAC≥400 group showed a higher progression rate than the other groups (p<0.001). In multivariable logistic regression, age (adjusted OR (aOR), 1.06; 95% CI, 1.02 to 1.09; p=0.001), CAC≥400 (aOR, 2.55 vs CAC 0 as a reference group; 95% CI, 1.19 to 5.46; p=0.016), body mass index (aOR, 1.09; 95% CI, 1.02 to 1.17; p=0.010) and initial peak aortic jet velocity (aOR, 1.21 per 0.1 m/s increase; 95% CI, 1.14 to 1.28; p<0.001) were associated with progression 1. In progression 2, CAC≥400 (aOR, 44.5 vs CAC 0 as a reference group; 95% CI, 1.09 to 1810; p=0.045), eGFR (aOR, 0.88; 95% CI, 0.80 to 0.97; p=0.007), left ventricular mass index (aOR, 1.05; 95% CI, 1.01 to 1.10; p=0.029) and initial peak aortic jet velocity (aOR, 4.21 per 0.1 m/s increase; 95% CI, 1.86 to 9.53; p=0.001) were significant determinants. CONCLUSIONS: CAC was significantly associated with the progression of CAVD. Particularly, CAC≥400 was linked to progression toward significant AS.