Association Between Aortic Valve Calcification and Myocardial Ischemia, Especially in Asymptomatic Patients

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FIGURE 1.
Patient disposition and results of MPS. Numbers of asymptomatic patients are also shown.
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FIGURE 2.
Representative case of aortic valve calcification. (A–C) Echocardiography shows focal area of increased echogenicity and thickness at noncoronary cusp of aortic valve (A and C, arrows). There are no restrictive leaflets, and valve opens well (B). (D) MPS shows extensive and severely reduced tracer uptake at lateral wall in stress images. Complete redistribution is observed in delayed images.

TABLE 1

Patient Characteristics and Comparison of Patients With and Without AVC

RAS inhibitors = renin-angiotensin system inhibitors (e.g., angiotensin-converting enzyme inhibitor, angiotensin type II receptor blocker, and direct renin inhibitor).

TABLE 2.

Multiple Logistic Regression Analyses for Inducible Myocardial Ischemia in All Patients

	Myocardial ischemia (SDS ≥ 3)			Moderate to severe ischemia (SDS ≥ 8)
Variable	OR	95% CI	P	OR	95% CI	P
Hypertension	1.10	0.76–1.61	0.62	1.78	0.97–3.47	0.073
Diabetes mellitus	0.99	0.70–1.40	0.96	0.95	0.57–1.58	0.85
Dyslipidemia	1.07	0.75–1.53	0.69	0.85	0.50–1.45	0.53
Hyperuricemia	0.95	0.65–1.39	0.80	1.02	0.58–1.75	0.95
Chronic kidney disease	1.16	0.82–1.65	0.41	1.38	0.82–2.34	0.23
Current smokers	1.18	0.75–1.82	0.47	1.29	0.68–2.37	0.41
AVC	1.56	1.10–2.23	0.013	2.16	1.26–3.80	0.0061

TABLE 3

Adjusted ORs of AVC for SDS ≥ 3 and SDS ≥ 8 in All Patients and Asymptomatic Patients

	Myocardial ischemia (SDS ≥ 3)			Moderate to severe ischemia (SDS ≥ 8)
Patients	OR	95% CI	P	OR	95% CI	P
All (n = 669)	1.56	1.10–2.23	0.013	2.16	1.26–3.80	0.0061
Asymptomatic (n = 311)	1.98	1.15–3.45	0.014	4.31	1.67–12.8	0.0043

Multivariate logistic regression models were adjusted for age, sex, hypertension, diabetes mellitus, dyslipidemia, hyperuricemia, current smoking, and chronic kidney disease.

TABLE 4

Comparison of Severity of Myocardial Ischemia According to Number of Calcified Leaflets in Patients with AVC (n = 342)

	No. of affected aortic leaflets
Variable	One (n = 148)	Two (n = 113)	Three (n = 81)	P
Mean SDS ± SD	3.03 ± 4.32	3.23 ± 4.48	2.70 ± 4.25	0.71
SDS ≥ 3 (n)	56 (37.8%)	44 (38.9%)	24 (29.6%)	0.36
SDS ≥ 8 (n)	21 (14.2%)	14 (12.4%)	11 (13.6%)	0.91