Nicola Gaibazzi1, Thomas R Porter2, Eustachio Agricola3, Giovanni Cioffi4, Carmine Mazzone5, Valentina Lorenzoni6, Lisa Albertini7, Giacomo Faden8, Mohammed Chamsi Pasha2, Bipul Biabhav2, Damiano Regazzoli3, Andrea Di Lenarda5, Pompilio Faggiano8. 1. Department of Cardiology, Parma University Hospital, Parma, Italy. Electronic address: ngaibazzi@gmail.com. 2. Section of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska. 3. Division of Non-Invasive Cardiology, San Raffaele Hospital, Milan, Italy. 4. Echocardiography Laboratory, Villa Bianca Hospital, Trento, Italy. 5. Cardiovascular Center, Azienda Sanitaria di Trieste, Trieste, Italy. 6. Scuola Superiore Sant'Anna, Pisa, Italy. 7. Department of Cardiology, Parma University Hospital, Parma, Italy. 8. Department of Cardiology, University of Brescia, Brescia, Italy.
Abstract
OBJECTIVES: The value of the echocardiographic calcium score (eCS) was evaluated to predict cardiac events in a multicenter cohort of subjects without known coronary disease, who underwent stress echocardiography (SE) for suspected coronary artery disease (CAD). BACKGROUND: Several studies have established that aortic valve sclerosis and/or calcification and mitral calcification, as detected by echocardiography, predict cardiovascular morbidity and mortality. The use of a semiquantitative total cardiac calcium score (eCS) to assess aortic and mitral valves, papillary muscles, and the ascending aorta has never been tested in multicenter studies; the inherent subjectivity and clinical applicability of such a parameter remains a concern. METHODS: We identified 1,303 patients from 5 Italian institutions and 1 U.S. institution, who had no known CAD and who underwent clinically-indicated pharmacological or exercise SE. They were followed up for myocardial infarction (MI) and all-cause death. eCS was assessed from archived images, and its discrimination and reclassification prognostic potential was determined. RESULTS: Fifty-eight patients met the combined endpoint of all-cause death (n = 37; 2.8%) or MI (n = 21; 1.6%) during a median follow-up of 808 days. Age, diabetes mellitus, eCS >0, and ischemic SE were multivariate predictors of hard events. Kaplan-Meier curves demonstrated that patients with ischemic SE or eCS >0 had worse outcomes. When both variables were abnormal, the prognosis was worse (p < 0.001). The multivariate model demonstrated that both eCS and ischemic SE independently contributed to risk prediction more than clinical variables. Both wall motion during SE and eCS were able to significantly reclassify the risk of events, but only stress wall motion demonstrated an incremental discrimination value. CONCLUSIONS: eCS demonstrated significant prognostic value in predicting hard cardiac events in a multicenter population of patients who required noninvasive evaluation. Its value was independent from clinical assessment and wall motion during SE, although it did not show incremental value over these factors for discrimination of patients with and without events.
OBJECTIVES: The value of the echocardiographic calcium score (eCS) was evaluated to predict cardiac events in a multicenter cohort of subjects without known coronary disease, who underwent stress echocardiography (SE) for suspected coronary artery disease (CAD). BACKGROUND: Several studies have established that aortic valve sclerosis and/or calcification and mitral calcification, as detected by echocardiography, predict cardiovascular morbidity and mortality. The use of a semiquantitative total cardiac calcium score (eCS) to assess aortic and mitral valves, papillary muscles, and the ascending aorta has never been tested in multicenter studies; the inherent subjectivity and clinical applicability of such a parameter remains a concern. METHODS: We identified 1,303 patients from 5 Italian institutions and 1 U.S. institution, who had no known CAD and who underwent clinically-indicated pharmacological or exercise SE. They were followed up for myocardial infarction (MI) and all-cause death. eCS was assessed from archived images, and its discrimination and reclassification prognostic potential was determined. RESULTS: Fifty-eight patients met the combined endpoint of all-cause death (n = 37; 2.8%) or MI (n = 21; 1.6%) during a median follow-up of 808 days. Age, diabetes mellitus, eCS >0, and ischemic SE were multivariate predictors of hard events. Kaplan-Meier curves demonstrated that patients with ischemic SE or eCS >0 had worse outcomes. When both variables were abnormal, the prognosis was worse (p < 0.001). The multivariate model demonstrated that both eCS and ischemic SE independently contributed to risk prediction more than clinical variables. Both wall motion during SE and eCS were able to significantly reclassify the risk of events, but only stress wall motion demonstrated an incremental discrimination value. CONCLUSIONS: eCS demonstrated significant prognostic value in predicting hard cardiac events in a multicenter population of patients who required noninvasive evaluation. Its value was independent from clinical assessment and wall motion during SE, although it did not show incremental value over these factors for discrimination of patients with and without events.
Authors: Sarah Gleeson; Yi-Wen Liao; Clementina Dugo; Andrew Cave; Lifeng Zhou; Zina Ayar; Jonathan Christiansen; Tony Scott; Liane Dawson; Andrew Gavin; Todd T Schlegel; Patrick Gladding Journal: PLoS One Date: 2017-03-30 Impact factor: 3.240
Authors: Cilie C van 't Klooster; Hendrik M Nathoe; J Hjortnaes; Michiel L Bots; Ivana Isgum; Nikolas Lessmann; Yolanda van der Graaf; Tim Leiner; Frank L J Visseren Journal: Int J Cardiol Heart Vasc Date: 2020-03-17