Cardiac calcification by transthoracic echocardiography in patients with known or suspected coronary artery disease

Objectives: To estimate the correlation between the total heart calcification score index (CSI), assessed by echocardiography, left ventricle mass index (LVMI), Framingham risk score (FRS), and angiographically assessed coronary artery disease (CAD). Background: Aortic valve and root sclerosis (AVS, ARS) and mitral annular calcium (MAC) detected by echocardiography have been associated with atherosclerosis. FRS is recommended for estimation of total coronary heart disease risk over the course of 10 years. The anatomic extent of CAD can be assessed with coronary angiography. Total and cardiovascular mortality risk increases with increasing LVMI. Methods: 167 consecutive in-hospital patients (mean age 66.6 +/- 9.7 yrs, 119 men) underwent: 1) complete transthoracic echocardiography (TTE), with CSI assessment (from 0=normal to 10=diffuse calcification of aortic valve, mitral annulus and aortic root), 2) the FRS evaluation (FRS <= 10=low, FRS >= 11 and <= 20=average risk, and a FRS <= 21=high risk), and 3) coronary angiography (with Duke score evaluation, from 0=normal to 100=severe left main disease). Results: The mean CSI of the entire population was 3.94 +/- 2.1, with a mean of 2.75 +/- 2 in patients at low risk, with a progressive increase in patients at average risk (4.11 +/- 2.2), at high risk (4.7 +/- 1.7), respectively. CSI was associated with the presence of CAD (p=0.003) and the presence of abnormal LVMI (p=0.002). Conclusions: Echocardiographically assessed CSI is correlated to FRS, Duke score and LVMI and can provide a simple, radiation-free index of cardiovascular risk. (C) 2009 Elsevier Ireland Ltd. All rights reserved.