Key result
Aortic valve calcification was associated with the prevalence of obstructive coronary artery disease (AUC 0.749), and adding an aortic valve calcification score >61 to a coronary calcium score >400 improved net reclassification by 7.7%.
Why the study?
Does adding aortic valve calcification to coronary calcium score improve the prediction of obstructive coronary artery disease in patients without known coronary or valve disease?
Case-Control (n=154)
No
Does adding aortic valve calcification to coronary calcium score improve the prediction of obstructive coronary artery disease in patients without known coronary or valve disease?
Effect estimate: AUC 0.749
p-value: p=<0.001
Adding aortic valve calcification to coronary calcium scoring improves the prediction of obstructive coronary artery disease and may help better select patients for computed tomography angiography.
May support adding aortic valve calcification to coronary calcium scoring for obstructive CAD prediction; hypothesis-generating and requires prospective validation.
BACKGROUND: Aortic valve calcification shares risk factors with coronary artery disease. Coronary calcium has been used has a gatekeeper to performing coronary tomography angiography. The aim of this study was to evaluate aortic valve calcification as a predictor of obstructive coronary artery disease by computed tomography, and its possible usefulness, alongside with coronary calcium, to improve the decision of whether or not to proceed with computed tomography angiography. METHODS: Transversal case-control study including 154 consecutive patients (62 ± 12 years, 57.6 % female, without known coronary or valve disease) undergoing calcium scoring and angiography through computed tomography (Phillips Brilliance, 16-slice). Predictors of aortic valve calcification and obstructive coronary artery disease were identified. Usefulness of aortic valve calcification when added to calcium score for prediction of obstructive coronary artery disease was assessed by binary logistic regression and net reclassification index. RESULTS: Aortic valve calcification was associated with higher coronary calcium, extent and prevalence of obstructive coronary disease, which was identified in 22.1 % of patients and was discriminated by aortic valve calcium with an area under curve 0.749 (p < 0.001, Youden index: 61). A higher discriminative power was achieved with a model based on coronary and aortic valve calcification (AUC 0.900, p < 0.001). Compared with calcium score >400 as a gatekeeper to angiography, the association of aortic calcium >61 allowed a net reclassification index of +7.7 % of patients. CONCLUSIONS: Aortic valve calcification is associated with the prevalence and extent of obstructive coronary artery disease by computed tomography angiography and is an easy, fast and useful method to improve the selection of patients for angiography.
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FAUSTINO et al. (2015) conducted a case-control in Suspected coronary artery disease (n=154). Aortic valve calcification (AoVC) vs. Coronary artery calcium (CAC) alone was evaluated on Detection of obstructive coronary artery disease by computed tomography angiography (AUC 0.749, p=<0.001). Aortic valve calcification was associated with the prevalence of obstructive coronary artery disease (AUC 0.749), and adding an aortic valve calcification score >61 to a coronary calcium score >400 improved net reclassification by 7.7%.
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