High Aortic Valve Calcium: A Predictor for Incident Heart Failure?

Patients with higher aortic valve calcium may be at increased risk for developing heart failure (HF), according to results of a study published in Circulation: Cardiovascular Imaging.

This analysis was part of the Rotterdam Study, which is an ongoing, prospective, population-based cohort of adults recruited at age 45 years or older and followed every 3 to 4 years. In this analysis, a random subset of 2348 patients who received computed tomography (CT) between 2003 and 2006 and had follow-up data through 2016 were evaluated for aortic valve calcium and the development of HF.

The study population comprised individuals with a mean age of 68.5±6.6 years, 52% were women, 98% were White, they had a BMI of 27.6±3.9, 74.1% had hypertension, 12.5% had diabetes, and 15.8% were current smokers. At baseline, 747 had aortic valve calcium. The individuals with aortic valve calcium were older, fewer were women, they had higher systolic blood pressure, more had hypertension and a history of coronary heart disease, and more were on blood-pressure-lowering medications and statin therapy (all P <.001) compared with the no aortic valve calcium cohort.

In the multivariate linear regression analysis, left ventricular mass indexed by body surface area was associated with the presence of aortic valve calcium (b, 2.80; P =.001) and log aortic valve calcium per 1-unit increase (b, 1.13; P <.001), left atrium diameter with aortic valve calcium (b, 0.06; P =.020) and log aortic valve calcium per 1-unit increase (b, 0.01; P =.007), and left ventricular ejection fraction with aortic valve calcium (b, -0.68; P =.048).

At a median follow-up of 9.8 years, 182 incident HF events were diagnosed. Stratified by aortic valve calcium at baseline, 12.6% of those with aortic valve calcium and 5.5% without aortic valve calcium were diagnosed with HF.

Stratified by level of aortic valve calcium at baseline, those with aortic valve calcium levels of 800 or higher and aortic valve calcium levels of 300 to 799 had significantly higher rates of HF during follow-up compared with patients with lower levels of aortic valve calcium at baseline (P <.001).

In the fully-adjusted model, incident HF was associated with aortic valve calcium levels of 800 or more (subdistribution hazard ratio [sHR], 2.54; 95% CI, 1.31-4.90; P =.006) and aortic valve calcium levels of 300 to 799 (sHR, 2.36; 95% CI, 1.32-4.19; P =.004) compared with patients with no aortic valve calcium and log aortic valve calcium per 1-unit increase (sHR, 1.10; 95% CI, 1.03-1.18; P =.005).

The overall mortality rate was 23.7% during follow-up. Mortality risk did not depend on aortic valve calcium status.

In sensitivity analyses, the relationship between HF and aortic valve calcium was attenuated after excluding patients with aortic valve stenosis and those who developed coronary heart disease during follow-up.

These findings may not be generalizable to a more diverse population.

“In this prospective study among community-dwelling men and women free of HF, the presence of AVC [aortic valve calcium] and high levels of AVC were associated with left ventricular structure and increased risk of new-onset HF,” the study authors wrote. “Our results suggest that larger CT-assessed AVC could be an indicative of increased risk for development of HF.”