Prognostic role of abdominal aortic calcification in patients hospitalized for acute heart failure: a pilot study
A Sammarco, P Marchesi, R Motta, V Cianci, A Pizziol, W Ageno, G RossittoAbstract
Background
Hospitalization for acute heart failure (AHF) is associated with high in-hospital and post-discharge mortality, highlighting the need for improved early risk stratification. Detection of calcification in the coronary arteries has emerged as an established predictor of major adverse cardiovascular events; its presence and severity closely correlates with calcification in the abdominal aorta. Opportunistic detection of abdominal aortic calcification (AAC) on non-contrast abdominal CT has demonstrated prognostic value in selected high-risk populations, but evidence is lacking for HF.
Purpose
To investigate the prognostic value of abdominal aortic calcification for all-cause mortality in patients hospitalized for acute heart failure.
Methods
A single-center, retrospective, observational study including consecutive adult patients admitted to our University Hospital for AHF, defined by ICD discharge codes from the Emergency Department (ED), between January 2020 and October 2025. All patients were followed-up for all-cause mortality until November 2025. Results are limited to the sub-cohort of those admitted to our Emergency Medicine Ward. Eligibility required a non-contrast abdominal CT with slice thickness of 2.5-3.0 mm in a timeframe of five years before the index admission, reflecting CT imaging already available to the ED clinician; or within three years before or after the index event, reflecting CT imaging already and potentially available to the ED clinician if opportunistic screening were implemented. CT images were retrieved from the institutional PACS (Picture Archiving and Communication System). AAC was measured at the level of the infrarenal abdominal aorta down to the aortic bifurcation, using both total calcified plaque volume (mm³) and the Agatston scoring method, with a dedicated software (SYNAPSE). AAC was dichotomized based on median values; the primary outcome was overall survival (OS) from the index admission, assessed by log-rank test for low vs high ACC.
Results
596 patients were admitted to our ward for AHF (median age = 84 [76-89] years; 49% females). In the 77 patients with an abdominal CT available within five years before the index event, AAC volume was not associated with all-cause mortality over the entire follow-up (log-rank p = 0.287), nor with 90-day mortality (p = 0.352). Similarly, in 152 patients with a CT available in the three years before or after admission, AAC did not predict survival over the entire follow-up (log-rank p = 0.153) or at 90 days (p = 0.695). However, in both analyses, a non-significant trend toward worse long-term survival was observed in patients with higher abdominal aortic calcification burden. Analysis by Agatston score led to similar results.
Conclusion
In our pilot study, AAC was not significantly associated with short-term mortality in elderly patients hospitalized for AHF. Studies on larger cohorts are warranted to evaluate its prognostic role for long-term outcomes.For image description, please refer to the figure legend and surrounding text.