The Associations of Aortic Valve Sclerosis, Aortic Annular Increased Reflectivity, and Mitral Annular Calcification with Subsequent Aortic Stenosis in Older Individuals: Findings from the Cardiovascular Health Study

Background: Although aortic valve sclerosis (AVS) is well described as preceding aortic stenosis (AS), the as-sociations of AS with antecedent mitral annular calcification (MAC) and aortic annular increased reflectivity (AAIR) have not been characterized. In a population-based prospective study, the authors evaluated whether MAC, AAIR, and AVS are associated with the risk for incident AS.Methods: Among participants of the Cardiovascular Health Study free of AS at the 1994-1995 visit, the pres-ence of MAC, AAIR, AVS, and the combination of all three was evaluated in 3,041 participants. Cox proportional-hazards regression was used to assess the association between the presence of calcification and the incidence of moderate or severe AS in three nested models adjusting for factors associated with atherosclerosis and inflammation both relevant to the pathogenesis of AS.Results: Over a median follow-up period of 11.5 years (interquartile range, 6.7-17.0 years), 110 cases of inci-dent moderate or severe AS were ascertained. Strong positive associations with incident moderate or severe AS were found for all calcification sites after adjustment for the main model covariates: AAIR (hazard ratio [HR], 2.90; 95% CI, 1.95-4.32; P < .0005), AVS (HR, 2.20; 95% CI, 1.44-3.37; P < .0005), MAC (HR, 1.67; 95% CI, 1.14-2.45; P = .008), and the combination of all three (HR, 2.50; 95% CI, 1.65-3.78; P < .0005). In a secondary analysis, the risk for AS increased with the number of sites at which calcification was present.Conclusions: In a large cohort of community-dwelling elderly individuals, there were strong associations be-tween each of AAIR, AVS, MAC, and the combination of the three and incident moderate or severe AS. The novel finding that AAIR had a particularly strong association with incident AS, even after adjusting for other calcification sites, suggests its value in identifying individuals at risk for AS and potential inclusion in routine assessment by transthoracic echocardiography. (J Am Soc Echocardiogr 2023;36:41-9.)

Automated summary

This study found that aortic valve sclerosis, mitral annular calcification, and aortic annular increased reflectivity are associated with the risk of developing aortic stenosis. The study also revealed that aortic annular increased reflectivity has a particularly strong association with incident aortic stenosis, suggesting its potential use in identifying individuals at risk.