Association between cardiac valvular calcification and myocardial ischemia in asymptomatic high-risk patients with end-stage renal disease

Objective: Valvular calcification is associated with significant morbidity and mortality in patients with end stage renal disease (ESRD). This study examined the hypothesis that valvular calcification is a marker of myocardial ischemia in asymptomatic high-risk patients with ESRD. Methods: Echocardiography and myocardial perfusion single-photon emission computed tomography were performed in 285 asymptomatic high-risk patients with ESRD at initiation of dialysis. We evaluated the extent and severity of myocardial ischemia by the summed difference score (SDS) and defined the presence of myocardial ischemia as SDS >= 3 and moderate to severe ischemia as SDS >= 8. The presence of cardiac valvular calcification was assessed by echocardiography and defined as aortic valve calcification or mitral valve calcification. Results: Eighty-five (29.9%) patients had echocardiographic evidence of cardiac valvular calcification. The presence of myocardial ischemia was significantly associated with aortic valve calcification (odds ratio [OR] = 3.19; 95% confidence interval [CI] = 1.76-5.78; p < 0.001), mitral valve calcification (OR = 3.31; 95% CI = 1.74-6.28; p < 0.001), and cardiac valvular calcification (OR = 3.18; 95% CI = 1.79-5.65; p < 0.001). The presence of moderate to severe myocardial ischemia (SDS >= 8) was independently associated with cardiac valvular calcification (OR = 2.86; 95% CI = 1.12-7.27; p = 0.028). Conclusion: Valvular calcification was significantly associated with the presence of inducible myocardial ischemia in asymptomatic patients with ESRD, and may be a potential marker of patients at high-risk for the presence of silent myocardial ischemia. (C) 2013 Elsevier Ireland Ltd. All rights reserved.