Association Between Aortic Valve Calcification and Myocardial Ischemia, Especially in Asymptomatic Patients
Association Between Aortic Valve Calcification and Myocardial Ischemia, Especially in Asymptomatic Patients
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DOI：
10.2967/jnumed.111.099275
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发表时间：
2012-08
期刊：
影响因子：
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通讯作者：
Ryo Yamazato;Hideya Yamamoto;F. Tadehara;H. Teragawa;S. Kurisu;Y. Dohi;Ken Ishibashi;E. Kunita;Hiroto Utsunomiya;Toshiharu Oka;Y. Kihara
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文献类型：
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作者：
Ryo Yamazato;Hideya Yamamoto;F. Tadehara;H. Teragawa;S. Kurisu;Y. Dohi;Ken Ishibashi;E. Kunita;Hiroto Utsunomiya;Toshiharu Oka;Y. Kihara
主动脉瓣钙化（AVC）被认为是全身动脉硬化的表现。然而，目前尚不清楚AVC是否与心肌缺血有关。负荷心肌灌注断层显像（MPS）广泛应用于心肌缺血的诊断。然而，不推荐常规MPS，特别是在无症状患者中。因此，我们研究了这一假设，即存在的AVC是强烈相关的诱导心肌缺血，即使在无症状的患者。方法：我们调查了669例连续患者，他们接受了腺苷负荷201 Tl MPS和超声心动图检查。用总差评分（SDS）评价心肌缺血的程度和严重程度。我们将心肌缺血定义为SDS ≥ 3，中度至重度缺血定义为SDS ≥ 8。我们根据受累主动脉瓣叶的数量对AVC的严重程度进行了分类。我们还比较了按AVC严重程度分层的患者的平均SDS以及SDS ≥ 3和SDS ≥ 8的患病率。结果如下：AVC的存在与心肌缺血（比值比[OR]，1.56; 95%置信区间[CI]，1.10-2.23; P = 0.013）和中度至重度缺血（OR，2.16; 95% CI，1.26-3.80; P = 0.0061）显著相关。在311例无症状患者中，AVC与中度至重度缺血密切相关（OR，4.31; 95%CI，1.67-12.8; P = 0.0043）。然而，SDS值以及SDS ≥ 3和SDS ≥ 8的患病率并未随着受影响主动脉瓣叶数量的增加而增加。结论：AVC的存在可能与心肌缺血的存在有关，特别是在无症状患者中。然而，我们没有发现AVC的程度和诱导心肌缺血之间的关联。AVC的存在可能是一个有用的解剖标志，以帮助识别心肌缺血的高风险患者，特别是无症状的患者。
Aortic valve calcification (AVC) is recognized as a manifestation of systemic arteriosclerosis. However, it is unclear whether AVC is associated with myocardial ischemia. Stress myocardial perfusion SPECT (MPS) is widely used for the diagnosis of myocardial ischemia. However, routine MPS is not recommended, particularly in asymptomatic patients. Accordingly, we investigated the hypothesis that the presence of AVC is strongly associated with inducible myocardial ischemia, even among asymptomatic patients. Methods: We investigated 669 consecutive patients who underwent both adenosine stress 201Tl MPS and echocardiography. We evaluated the extent and severity of myocardial ischemia by the summed difference score (SDS). We defined the presence of myocardial ischemia as SDS ≥ 3 and moderate to severe ischemia as SDS ≥ 8. We classified the severity of AVC according to the number of affected aortic leaflets. We also compared the mean SDS and the prevalence of SDS ≥ 3 and SDS ≥ 8 among patients stratified by the severity of AVC. Results: The presence of AVC was significantly associated with myocardial ischemia (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.10–2.23; P = 0.013) and moderate to severe ischemia (OR, 2.16; 95% CI, 1.26–3.80; P = 0.0061). In 311 asymptomatic patients, AVC was strongly associated with moderate to severe ischemia (OR, 4.31; 95% CI, 1.67–12.8; P = 0.0043). However, the SDS value and the prevalence of SDS ≥ 3 and SDS ≥ 8 did not increase with increasing number of affected aortic leaflets. Conclusion: The presence of AVC may be associated with the presence of myocardial ischemia, particularly in asymptomatic patients. However, we found no association between the extent of AVC and inducible myocardial ischemia. The presence of AVC may be a useful anatomic marker to help identify patients at high risk of myocardial ischemia, particularly asymptomatic patients.