Stroke, baseline agatston score, and epicardial adipose tissue predict the progression rate of aortic valve calcification

Background

Aortic valve calcification (AVC) is a prevalent valvular disorder, with severe cases predisposing to valve stenosis. The progression of AVC and its associated determinants remain incompletely elucidated, and have been associated with valvular inflammation and lipid accumulation. Cardiac computed tomography (CT) has become an established imaging modality for assessing AVC progression and evaluating global cardiac inflammation.

Purpose

To investigate the risk factors associated with rapid progression of AVC.

Methods

We retrospectively screened 1,510 patients who underwent two separate cardiac CT examinations during hospitalizations at our hospital between 2013 and 2023, and enrolled 124 patients with AVC (Ethics Committee Approval No. S2024-041-01). The rate of AVC progression was quantified using the annualized Agatston score increase. Clinical data, serological markers, and cardiac CT parameters were collected to identify factors associated with the progression rate and to construct a multivariable linear regression model.

Results

The mean age of the cohort was 69.67 ± 10.67 years. The median interval between the two CT assessments was 27.50 [16.25, 48.00] months. The median baseline AVC Agatston score was 55.00 [22.00, 142.00] AU, and the median annualized AVC Agatston score progression rate was 13.5 [5.03, 34.22] AU per year (Figure1) .

Univariate analysis demonstrated that age (R² = 0.200, P=0.026), pulse pressure (R² = 0.233, P= 0.009), history of stroke(R² = 0.213, P= 0.018), coronary artery disease(R² = 0.288, P= 0.001), serum calcium level (R² = 0.187, P= 0.037), Aortic valve maximum velocity (R² = 0.187, P= 0.037), baseline AVC Agatston score(R² = 0.631, P< 0.001) (Figure2.A), and epicardial adipose tissue volume(R² = 0.362, P< 0.001) (Figure2.B) were associated with the annualized AVC progression rate. In multivariable linear regression analysis, history of stroke, baseline AVC Agatston score, and epicardial adipose tissue volume remained independently associated with an increased annualized progression rate(adjusted R² = 0.826, P < 0.001). Age, sex, BMI, pulse pressure, low-density lipoprotein, and serum calcium did not show statistical significance(Figure2.C).

Conclusions

History of stroke, baseline AVC Agatston score, and epicardial adipose tissue volume are independent risk factors for rapid AVC progression. Cardiac CT-derived morphological and history of stroke effectively predict rapid AVC progression, facilitating the identification of high-risk patients.Figure 2Figure 1