Echocardiographic aortic valve calcification and outcomes in women and men with aortic stenosis

Henrik K Thomassen, Giovanni Cioffi, Eva Gerdts, Eigir Einarsen, Helga Bergljot Midtbø, Costantino Mancusi, Dana Cramariuc, Henrik K Thomassen, Giovanni Cioffi, Eva Gerdts, Eigir Einarsen, Helga Bergljot Midtbø, Costantino Mancusi, Dana Cramariuc

Abstract

Objective: Sex differences in risk factors of aortic valve calcification (AVC) by echocardiography have not been reported from a large prospective study in aortic stenosis (AS).

Methods: AVC was assessed using a prognostically validated visual score and grouped into none/mild or moderate/severe AVC in 1725 men and women with asymptomatic AS in the Simvastatin Ezetimibe in Aortic Stenosis study. The severity of AS was assessed by the energy loss index (ELI) taking pressure recovery in the aortic root into account.

Results: More men than women had moderate/severe AVC at baseline despite less severe AS by ELI (p<0.01). Moderate/severe AVC at baseline was independently associated with lower aortic compliance and more severe AS in both sexes, and with increased high-sensitive C reactive protein (hs-CRP) only in men (all p<0.01). In Cox regression analyses, moderate/severe AVC at baseline was associated with a 2.5-fold (95% CI 1.64 to 3.80) higher hazard rate of major cardiovascular events in women, and a 2.2-fold higher hazard rate in men (95% CI 1.54 to 3.17) (both p<0.001), after adjustment for age, hypertension, study treatment, aortic compliance, left ventricular (LV) mass and systolic function, AS severity and hs-CRP. Moderate/severe AVC at baseline also predicted a 1.8-fold higher hazard rate of all-cause mortality in men (95% CI 1.04 to 3.06, p<0.05) independent of age, AS severity, LV mass and aortic compliance, but not in women.

Conclusion: In conclusion, AVC scored by echocardiography has sex-specific characteristics in AS. Moderate/severe AVC is associated with higher cardiovascular morbidity in both sexes, and with higher all-cause mortality in men.

Trial registration number: ClinicalTrials.gov identifier: NCT00092677.

Keywords: aortic valve calcification; aortic valve stenosis; echocardiography; prognosis; sex.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Bland-Altman analyses of the aortic valve calcification (AVC) visual score measured by two different readers (A) and twice by the same reader (B) with the mean value of the difference between measurements (the solid reference line in each panel) and 95% limits of agreement (the dotted lines in each panel).
Figure 2
Figure 2
Severity of aortic stenosis by the energy loss index assessed in women and men and in the two aortic valve calcification (AVC) subgroups: no/mild AVC and moderate/severe AVC. p value

Figure 3

Kaplan-Meier curves reporting survival free…

Figure 3

Kaplan-Meier curves reporting survival free of major cardiovascular events (A), and survival (B)…

Figure 3
Kaplan-Meier curves reporting survival free of major cardiovascular events (A), and survival (B) in women (left panels) and men (right panels). AVC, aortic valve calcification.
Figure 3
Figure 3
Kaplan-Meier curves reporting survival free of major cardiovascular events (A), and survival (B) in women (left panels) and men (right panels). AVC, aortic valve calcification.

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