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From Affiliated Egyptian Universities and Cardiology Centers

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Background: Aortic valve sclerosis (AVS) and mitral annular calcification (MAC) detected by echocardiography may represent an atherosclerosis-like degenerative process. Many studies showed that AVS and/or MAC are considered indicators for the presence of coronary artery disease (CAD). Multidetector computed tomography (MDCT) became very helpful in assessing coronary, valvular as well as aortic wall calcification. The aim of this study is to test the hypothesis that extracoronary calcification is associated with extensive atherosclerosis in coronary arteries of young patients.
Methods: We studied 111 patients below age 65 years who were scheduled for coronary angiography (CA). Transthoracic echocardiography was done to assess the presence of AVS and/or MAC. Calcium score in the coronary arteries (CCS), aortic valve (AVC), mitral annulus (MAC), aortic arch (AAC) and descending aorta (DAC) were measured by MDCT. According to CA results, we consider the presence of ≥50% diameter stenosis of any major epicardial vessel to be an obstructive coronary artery lesion (OCAL).
Results: Patients with AVS and/or MAC had significantly higher number of OCAL (4.2±2.2 vs. 1.2±1.1, p <0.001). The total number of OCAL was positively correlated with AVC, and AAC. CCS>0 had a sensitivity of 85.6% and accuracy of 80.2% for detection of CAD. Combining CCS >0 with any AVC or aortic wall calcium (AAC or DAC) increased the sensitivity to 90% for both, and accuracy to 83% and 84% respectively.
Conclusions: Extracoronary calcification as detected by echocardiography and MDCT helps prediction of significant coronary atherosclerosis in young patients.
Keywords: Atherosclerosis, Extracoronary calcification, echocardiography, MDCT
(Heart Mirror J 2009; 3(2): 70-75)