Prognostic value of echocardiographic calcium score in patients with a clinical indication for stress echocardiography

Nicola Gaibazzi, Thomas R. Porter, Eustachio Agricola, Giovanni Cioffi, Carmine Mazzone, Valentina Lorenzoni, Lisa Albertini, Giacomo Faden, Mohammed Chamsi Pasha, Bipul Biabhav, Damiano Regazzoli, Andrea Di Lenarda, Pompilio Faggiano

Research output: Contribution to journalArticle

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Abstract

Objectives The value of the echocardiographic calcium score (eCS) was evaluated to predict cardiac events in a multicenter cohort of subjects without known coronary disease, who underwent stress echocardiography (SE) for suspected coronary artery disease (CAD). Background Several studies have established that aortic valve sclerosis and/or calcification and mitral calcification, as detected by echocardiography, predict cardiovascular morbidity and mortality. The use of a semiquantitative total cardiac calcium score (eCS) to assess aortic and mitral valves, papillary muscles, and the ascending aorta has never been tested in multicenter studies; the inherent subjectivity and clinical applicability of such a parameter remains a concern. Methods We identified 1,303 patients from 5 Italian institutions and 1 U.S. institution, who had no known CAD and who underwent clinically-indicated pharmacological or exercise SE. They were followed up for myocardial infarction (MI) and all-cause death. eCS was assessed from archived images, and its discrimination and reclassification prognostic potential was determined. Results Fifty-eight patients met the combined endpoint of all-cause death (n = 37; 2.8%) or MI (n = 21; 1.6%) during a median follow-up of 808 days. Age, diabetes mellitus, eCS >0, and ischemic SE were multivariate predictors of hard events. Kaplan-Meier curves demonstrated that patients with ischemic SE or eCS >0 had worse outcomes. When both variables were abnormal, the prognosis was worse (p <0.001). The multivariate model demonstrated that both eCS and ischemic SE independently contributed to risk prediction more than clinical variables. Both wall motion during SE and eCS were able to significantly reclassify the risk of events, but only stress wall motion demonstrated an incremental discrimination value. Conclusions eCS demonstrated significant prognostic value in predicting hard cardiac events in a multicenter population of patients who required noninvasive evaluation. Its value was independent from clinical assessment and wall motion during SE, although it did not show incremental value over these factors for discrimination of patients with and without events.

Original languageEnglish
Pages (from-to)389-396
Number of pages8
JournalJACC: Cardiovascular Imaging
Volume8
Issue number4
DOIs
Publication statusPublished - Apr 1 2015

Fingerprint

Stress Echocardiography
Calcium
Aortic Valve
Coronary Artery Disease
Cause of Death
Myocardial Infarction
Papillary Muscles
Sclerosis
Mitral Valve
Multicenter Studies
Coronary Disease
Echocardiography
Aorta
Diabetes Mellitus
Pharmacology
Exercise
Morbidity
Mortality

Keywords

  • calcium score
  • cardiac events
  • echocardiography
  • prognosis
  • stress echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Prognostic value of echocardiographic calcium score in patients with a clinical indication for stress echocardiography. / Gaibazzi, Nicola; Porter, Thomas R.; Agricola, Eustachio; Cioffi, Giovanni; Mazzone, Carmine; Lorenzoni, Valentina; Albertini, Lisa; Faden, Giacomo; Chamsi Pasha, Mohammed; Biabhav, Bipul; Regazzoli, Damiano; Di Lenarda, Andrea; Faggiano, Pompilio.

In: JACC: Cardiovascular Imaging, Vol. 8, No. 4, 01.04.2015, p. 389-396.

Research output: Contribution to journalArticle

Gaibazzi, N, Porter, TR, Agricola, E, Cioffi, G, Mazzone, C, Lorenzoni, V, Albertini, L, Faden, G, Chamsi Pasha, M, Biabhav, B, Regazzoli, D, Di Lenarda, A & Faggiano, P 2015, 'Prognostic value of echocardiographic calcium score in patients with a clinical indication for stress echocardiography', JACC: Cardiovascular Imaging, vol. 8, no. 4, pp. 389-396. https://doi.org/10.1016/j.jcmg.2014.10.014
Gaibazzi, Nicola ; Porter, Thomas R. ; Agricola, Eustachio ; Cioffi, Giovanni ; Mazzone, Carmine ; Lorenzoni, Valentina ; Albertini, Lisa ; Faden, Giacomo ; Chamsi Pasha, Mohammed ; Biabhav, Bipul ; Regazzoli, Damiano ; Di Lenarda, Andrea ; Faggiano, Pompilio. / Prognostic value of echocardiographic calcium score in patients with a clinical indication for stress echocardiography. In: JACC: Cardiovascular Imaging. 2015 ; Vol. 8, No. 4. pp. 389-396.
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abstract = "Objectives The value of the echocardiographic calcium score (eCS) was evaluated to predict cardiac events in a multicenter cohort of subjects without known coronary disease, who underwent stress echocardiography (SE) for suspected coronary artery disease (CAD). Background Several studies have established that aortic valve sclerosis and/or calcification and mitral calcification, as detected by echocardiography, predict cardiovascular morbidity and mortality. The use of a semiquantitative total cardiac calcium score (eCS) to assess aortic and mitral valves, papillary muscles, and the ascending aorta has never been tested in multicenter studies; the inherent subjectivity and clinical applicability of such a parameter remains a concern. Methods We identified 1,303 patients from 5 Italian institutions and 1 U.S. institution, who had no known CAD and who underwent clinically-indicated pharmacological or exercise SE. They were followed up for myocardial infarction (MI) and all-cause death. eCS was assessed from archived images, and its discrimination and reclassification prognostic potential was determined. Results Fifty-eight patients met the combined endpoint of all-cause death (n = 37; 2.8{\%}) or MI (n = 21; 1.6{\%}) during a median follow-up of 808 days. Age, diabetes mellitus, eCS >0, and ischemic SE were multivariate predictors of hard events. Kaplan-Meier curves demonstrated that patients with ischemic SE or eCS >0 had worse outcomes. When both variables were abnormal, the prognosis was worse (p <0.001). The multivariate model demonstrated that both eCS and ischemic SE independently contributed to risk prediction more than clinical variables. Both wall motion during SE and eCS were able to significantly reclassify the risk of events, but only stress wall motion demonstrated an incremental discrimination value. Conclusions eCS demonstrated significant prognostic value in predicting hard cardiac events in a multicenter population of patients who required noninvasive evaluation. Its value was independent from clinical assessment and wall motion during SE, although it did not show incremental value over these factors for discrimination of patients with and without events.",
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AU - Gaibazzi, Nicola

AU - Porter, Thomas R.

AU - Agricola, Eustachio

AU - Cioffi, Giovanni

AU - Mazzone, Carmine

AU - Lorenzoni, Valentina

AU - Albertini, Lisa

AU - Faden, Giacomo

AU - Chamsi Pasha, Mohammed

AU - Biabhav, Bipul

AU - Regazzoli, Damiano

AU - Di Lenarda, Andrea

AU - Faggiano, Pompilio

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N2 - Objectives The value of the echocardiographic calcium score (eCS) was evaluated to predict cardiac events in a multicenter cohort of subjects without known coronary disease, who underwent stress echocardiography (SE) for suspected coronary artery disease (CAD). Background Several studies have established that aortic valve sclerosis and/or calcification and mitral calcification, as detected by echocardiography, predict cardiovascular morbidity and mortality. The use of a semiquantitative total cardiac calcium score (eCS) to assess aortic and mitral valves, papillary muscles, and the ascending aorta has never been tested in multicenter studies; the inherent subjectivity and clinical applicability of such a parameter remains a concern. Methods We identified 1,303 patients from 5 Italian institutions and 1 U.S. institution, who had no known CAD and who underwent clinically-indicated pharmacological or exercise SE. They were followed up for myocardial infarction (MI) and all-cause death. eCS was assessed from archived images, and its discrimination and reclassification prognostic potential was determined. Results Fifty-eight patients met the combined endpoint of all-cause death (n = 37; 2.8%) or MI (n = 21; 1.6%) during a median follow-up of 808 days. Age, diabetes mellitus, eCS >0, and ischemic SE were multivariate predictors of hard events. Kaplan-Meier curves demonstrated that patients with ischemic SE or eCS >0 had worse outcomes. When both variables were abnormal, the prognosis was worse (p <0.001). The multivariate model demonstrated that both eCS and ischemic SE independently contributed to risk prediction more than clinical variables. Both wall motion during SE and eCS were able to significantly reclassify the risk of events, but only stress wall motion demonstrated an incremental discrimination value. Conclusions eCS demonstrated significant prognostic value in predicting hard cardiac events in a multicenter population of patients who required noninvasive evaluation. Its value was independent from clinical assessment and wall motion during SE, although it did not show incremental value over these factors for discrimination of patients with and without events.

AB - Objectives The value of the echocardiographic calcium score (eCS) was evaluated to predict cardiac events in a multicenter cohort of subjects without known coronary disease, who underwent stress echocardiography (SE) for suspected coronary artery disease (CAD). Background Several studies have established that aortic valve sclerosis and/or calcification and mitral calcification, as detected by echocardiography, predict cardiovascular morbidity and mortality. The use of a semiquantitative total cardiac calcium score (eCS) to assess aortic and mitral valves, papillary muscles, and the ascending aorta has never been tested in multicenter studies; the inherent subjectivity and clinical applicability of such a parameter remains a concern. Methods We identified 1,303 patients from 5 Italian institutions and 1 U.S. institution, who had no known CAD and who underwent clinically-indicated pharmacological or exercise SE. They were followed up for myocardial infarction (MI) and all-cause death. eCS was assessed from archived images, and its discrimination and reclassification prognostic potential was determined. Results Fifty-eight patients met the combined endpoint of all-cause death (n = 37; 2.8%) or MI (n = 21; 1.6%) during a median follow-up of 808 days. Age, diabetes mellitus, eCS >0, and ischemic SE were multivariate predictors of hard events. Kaplan-Meier curves demonstrated that patients with ischemic SE or eCS >0 had worse outcomes. When both variables were abnormal, the prognosis was worse (p <0.001). The multivariate model demonstrated that both eCS and ischemic SE independently contributed to risk prediction more than clinical variables. Both wall motion during SE and eCS were able to significantly reclassify the risk of events, but only stress wall motion demonstrated an incremental discrimination value. Conclusions eCS demonstrated significant prognostic value in predicting hard cardiac events in a multicenter population of patients who required noninvasive evaluation. Its value was independent from clinical assessment and wall motion during SE, although it did not show incremental value over these factors for discrimination of patients with and without events.

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