Prognostic Value of Calcium Score on Echocardiography | Journal Scan

Study Questions:

What is the prognostic significance of an echocardiographic calcium score in patients referred for stress echocardiography?


This study examined 1,303 patients from multiple sites undergoing clinically indicated stress echocardiography (exercise or pharmacologic) with no known history of coronary artery disease, and evaluated the relationship between a calcium score on echocardiography and adverse events including all-cause mortality and nonfatal myocardial infarction. Calcification assessment included the presence of any papillary muscle calcium or ascending aorta calcification, and the presence and grade of mitral annular calcification and aortic valve calcification.


Mean age was 63 ± 12 years, and 57% were male. Mean follow-up was 808 days, and there were 58 events (death = 37, myocardial infarction = 21). Any calcification was present in 42% of patients, and stress-induced wall motion abnormalities were noted in 12%. The optimal cutoff to predict adverse events was a calcification score >0, with a sensitivity of 74% and specificity of 60% (area under the curve, 0.67). After adjustment for baseline characteristics and inducible wall motion abnormalities on echocardiography, the presence of any calcification by echocardiography was associated with an increased risk of adverse events (hazard ratio, 2.6; 95% confidence interval, 1.4-4.9; p = 0.002).


The presence of any echocardiographic calcification involving the papillary muscles, mitral annulus, aortic valve, or ascending aorta is independently associated with adverse events.


These results find that calcium seen by echocardiography identifies patients at increased risk of death or myocardial infarction. However, the practical relevance of this remains unclear. What should we do with this information? Are there any treatment options that alter outcomes in these patients? We simply do not know. This may be similar to coronary computed tomography calcification, which has been associated with increased risk of adverse events in many large studies. Nevertheless, we have failed to demonstrate convincing evidence that targeted therapy of patients with elevated coronary calcification alters outcomes. Calcification noted on echocardiography may be in a similar situation; until we have data demonstrating that treatment changes outcomes, it is hard to know what to do with these findings.

Clinical Topics: Noninvasive Imaging, Valvular Heart Disease, Atherosclerotic Disease (CAD/PAD), Echocardiography/Ultrasound

Keywords: Aorta, Aortic Valve Stenosis, Aortic Valve, Calcinosis, Coronary Artery Disease, Coronary Disease, Echocardiography, Stress, Mortality, Myocardial Infarction, Papillary Muscles, Tomography, Vascular Calcification

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