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Valvular heart disease
Original research article
Echocardiographic aortic valve calcification and outcomes in women and men with aortic stenosis
  1. Henrik K Thomassen1,
  2. Giovanni Cioffi2,
  3. Eva Gerdts1,
  4. Eigir Einarsen1,
  5. Helga Bergljot Midtbø1,
  6. Costantino Mancusi3,
  7. Dana Cramariuc4
  1. 1 Department of Clinical Science, University of Bergen, Bergen, Norway
  2. 2 Department of Cardiology, Cura Villa Bianca Hospital, Trento, Italy
  3. 3 Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
  4. 4 Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
  1. Correspondence to Dr. Dana Cramariuc, Department of Heart Disease, Haukeland University Hospital, 5021 Bergen, Norway; cramariuc_dana{at}yahoo.com

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

  • aortic valve calcification
  • aortic valve stenosis
  • sex
  • prognosis
  • echocardiography

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/heartjnl-2016-311040

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    Footnotes

    • Contributors HKT, GC, EG and DC were involved in the conception and design, as well as in the analysis and interpretation of data. All coauthors have revised the manuscript critically and approved it for submission.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval The SEAS study was approved by ethics committees in all participating study centers, and all patients provided written informed consent.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Correction notice Since this paper was first published online the author name Constantino Mancusi has been updated to Costantino Mancusi.

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