Cardiovascular morbidity and mortality in patients with aortic valve calcification: A systematic review and meta-analysis

Matteo Nicola Dario Di Minno, Paolo Poggio, Edoardo Conte, Veronika Myasoedova, Paola Songia, Saima Mushtaq, Laura Cavallotti, Donato Moschetta, Alessandro Di Minno, Gaia Spadarella, Paolo Pizzicato, Gianluca Pontone, Mauro Pepi, Daniele Andreini

Research output: Contribution to journalArticlepeer-review


Background: Aortic valve calcification (AVC) is an active process that involves inflammation, disorganization of matrix disposition, lipid accumulation and lamellar bone formation. AVC without hemodynamic changes has been associated with cardiovascular (CV) risk factors and increased risk of coronary and CV events. Nowadays, echocardiography is the standard imaging technique to evaluate aortic valve pathologies. However, cardiac computed tomography (CT) allows high accuracy and reproducible measurement of AVC, without exposing the patients to excessive radiation or contrast administration. Aims: To better understand if AVC assessment may improve CV risk-prediction, we performed a systematic search and meta-analysis of literature studies, evaluating the relationship among AVC, coronary artery disease (CAD), and overall mortality. Methods and results: A detailed search, according to PRISMA guidelines, was performed to identify all available studies investigating AVC, measured by CT scan, and CV events. Thirteen studies on 3,782 AVC patients and 32,890 controls were included in the final analysis. Patients with AVC have a higher risk of CAD (OR 1.7, 95%CI: 1.04–2.87; p = 0.04) when compared to controls. We also found an association between AVC and coronary artery calcification (OR 3.8; 95%CI: 2.4–6.0; p < 0.001.) Finally, AVC had 93.2% specificity for overall mortality (95%CI: 92.8–93.6) with a negative predictive value of 98.8% (95%CI: 98.7–98.8). Conclusion: AVC is associated with coronary artery calcification and overall mortality. The present data cannot support the use of cardiac CT over echocardiography for AVC assessment in all patients, but when cardiac CT is performed for suspected CAD, AVC evaluation may contribute to risk stratification and patient management. Ad hoc designed studies should address this issue in the next future.

Original languageEnglish
Pages (from-to)190-195
Number of pages6
JournalJournal of Cardiovascular Computed Tomography
Issue number4
Publication statusPublished - Jul 1 2019


  • Aortic valve calcification
  • Coronary artery calcification
  • Overall morality

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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