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Clinical research study
Abdominal aortic and iliac artery aneurysms
The prognostic impact of vascular calcification on abdominal aortic aneurysm progression
Under a Creative Commons license
Open access
Abstract
Objective
The maximal aortic diameter is currently the only clinically applied predictor of abdominal aortic aneurysm (AAA) progression. It is known that the risk of rupture is associated with aneurysm size; hence, accurate monitoring of AAA expansion is crucial. Aneurysmal vessel wall calcification and its implication on AAA expansion are insufficiently explored. We evaluated the vascular calcification using longitudinal computed tomography angiographies (CTA) of patients with an AAA and its association with AAA growth.
Methods
We conducted a retrospective study of 102 patients with an AAA with a total of 389 abdominal CTAs at 6-month intervals, treated and followed at the Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna. Digitally stored CTAs were reviewed for vascular calcification (volume and score) of the infrarenal aorta and common iliac arteries as well as for morphometric AAA analysis. In the prognostic setting, slow versus fast AAA progression was defined as a less than 2 mm or a 2-mm or greater increase in AAA diameter over 6 months. In addition, to analyze the association of vascular calcification and the AAA growth rate with longitudinal monitoring data, a specifically tailored log-linear mixed model was used.
Results
An inverse relation of increased abdominal vessel wall calcification and short-term AAA progression was detected. Compared with fast progressing AAA, the median calcification volume of the infrarenal aorta (1225.3 mm³ vs 519.8 mm³; P = .003), the median total calcification volume (2014.1 mm³ vs 1434.9 mm³; P = .008), and the median abdominal total customized Agatston calcium (cAC) score (1663.5 vs 718.4; P = .003) were significantly increased in slow progressing AAA. Importantly, a log-linear mixed model efficiently predicted AAA expansion based on current diameter and abdominal total cAC score (P = .042).
Conclusions
We assessed the prognostic value of CTA-measured vascular calcification for AAA progression. Increased vascular calcification stabilizes the aortic aneurysmal wall and likely protects against progressive AAA expansion, resulting in a significant decrease of aneurysm growth over time. As a consequence, this may have implications for rupture risk, mortality, morbidity, and cost.
Keywords
Abdominal aortic aneurysm
Growth prediction
Vascular calcification
Calcification volume
Calcification score
Computed tomography angiography
Cited by (0)
© 2021 The Authors. Published by Elsevier Inc. on behalf of the Society for Vascular Surgery.
Is aortic valve calcification a sign I am developing heart disease?
Answer From Francisco Lopez-Jimenez, M.D.
The aortic valve is between the lower left heart chamber and the body's main artery (aorta). Aortic valve calcification is a condition in which calcium deposits form on the aortic valve. These deposits can cause the valve opening to become narrow. Severe narrowing can reduce blood flow through the aortic valve — a condition called aortic valve stenosis.
Aortic valve calcification may be an early sign of heart disease, even if there aren't any other heart disease symptoms.
Calcification and stenosis generally affect older adults. When it occurs in younger people, it's often caused by:
- A heart defect that's present at birth (congenital heart defect)
- Other illnesses, such as kidney failure
Aortic valve sclerosis — thickening and stiffness of the valve and mild aortic calcification — usually doesn't cause significant heart problems. But it requires regular checkups to make sure the condition isn't worsening. If the valve becomes severely narrowed (stenotic), aortic valve replacement surgery may be necessary.
With
Francisco Lopez-Jimenez, M.D.
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July 09, 2022
- Gaasch WH, et al. Natural history, epidemiology, and prognosis of aortic stenosis. //www.uptodate.com/contents/search. Accessed April 1, 2022.
- Naish J, et al., eds. The cardiovascular system. In: Medical Sciences. 3rd ed. Elsevier; 2019. //www.clinicalkey.com. Accessed March 31, 2022.
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- Otto CM, et al. 2020 ACC/AHA Guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2021; doi:10.1016/j.jacc.2020.11.018.
- AskMayoExpert. Aortic stenosis (adult). Mayo Clinic; 2021.
- Dweck M, et al. Aortic valve sclerosis and pathogenesis of calcific aortic stenosis. //www.uptodate.com/contents/search. Accessed April 1, 2022.
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