Aortic and Mitral Calcification Is Marker of Significant Carotid and Limb Atherosclerosis in Patients with First Acute Coronary Syndrome
Anna Sannino M.D.
Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
Search for more papers by this authorCorresponding Author
Maria-Angela Losi M.D.
Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
Address for correspondence and reprint requests: Maria-Angela Losi, M.D., Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, Naples 80131, Italy. Fax: +39-081-7462256;
E-mail: [email protected]
Search for more papers by this authorGiuseppe Giugliano M.D.
Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
Coronary Care Unit, Montevergine Clinic, Mercogliano, AV, Italy
Search for more papers by this authorGrazia Canciello M.S.
Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
Search for more papers by this authorEvelina Toscano M.D.
Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
Search for more papers by this authorAlessandra Giamundo M.D.
Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
Search for more papers by this authorFernando Scudiero M.D.
Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
Search for more papers by this authorLinda Brevetti M.D.
Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
Search for more papers by this authorLaura Scudiero M.D.
Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
Search for more papers by this authorMaria Prastaro M.D.
Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
Search for more papers by this authorCinzia Perrino M.D., Ph.D.
Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
Search for more papers by this authorPasquale Perrone-Filardi M.D.
Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
Search for more papers by this authorMaurizio Galderisi M.D.
Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
Search for more papers by this authorBruno Trimarco M.D.
Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
Search for more papers by this authorGiovanni Esposito M.D., Ph.D.
Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
Search for more papers by this authorAnna Sannino M.D.
Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
Search for more papers by this authorCorresponding Author
Maria-Angela Losi M.D.
Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
Address for correspondence and reprint requests: Maria-Angela Losi, M.D., Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, Naples 80131, Italy. Fax: +39-081-7462256;
E-mail: [email protected]
Search for more papers by this authorGiuseppe Giugliano M.D.
Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
Coronary Care Unit, Montevergine Clinic, Mercogliano, AV, Italy
Search for more papers by this authorGrazia Canciello M.S.
Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
Search for more papers by this authorEvelina Toscano M.D.
Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
Search for more papers by this authorAlessandra Giamundo M.D.
Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
Search for more papers by this authorFernando Scudiero M.D.
Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
Search for more papers by this authorLinda Brevetti M.D.
Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
Search for more papers by this authorLaura Scudiero M.D.
Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
Search for more papers by this authorMaria Prastaro M.D.
Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
Search for more papers by this authorCinzia Perrino M.D., Ph.D.
Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
Search for more papers by this authorPasquale Perrone-Filardi M.D.
Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
Search for more papers by this authorMaurizio Galderisi M.D.
Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
Search for more papers by this authorBruno Trimarco M.D.
Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
Search for more papers by this authorGiovanni Esposito M.D., Ph.D.
Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
Search for more papers by this authorAbstract
Purpose
Atherosclerosis is a systemic disease and coronary artery disease is frequently associated with peripheral artery disease. As aortic and mitral valvular calcification (VC) share some etiopathogenetic mechanisms with atherosclerosis, we analyzed the risk profile and the echocardiographic characteristics of patients admitted for first acute coronary syndrome (ACS) to investigate whether the presence of VC could be a marker of asymptomatic hemodynamically significant peripheral atherosclerosis.
Methods
A total of 151 patients admitted for ACS without previous history of cardiovascular disease were consecutively enrolled. The presence of VC was identified by echocardiography; a carotid stenosis ≥50% by ultrasound identified carotid artery disease (CarAD); an ankle–brachial index ≤0.9 or ≥1.4 identified lower extremity artery disease (LEAD). Significant peripheral atherosclerosis was defined by the presence of CarAD and/or LEAD.
Results
Peripheral atherosclerosis was diagnosed in 82 (54.3%) patients; isolated CarAD in 24, isolated LEAD in 20, both diseases in 38 patients. VC was present in 103 (68.2%) patients. By multivariate analysis, age (OR = 1.059, 95% CI 1.007–1.113, P = 0.025), diabetes mellitus (OR = 5.068, 95% CI 1.480–17.351, P = 0.010), VC (OR = 7.422, 95% CI 2.421–22.880, P < 0.001), and multivessel CAD (OR = 3.317, 95% CI 1.281–8.586, P = 0.013) were the only independent predictors of having peripheral atherosclerosis. C-statistic for VC was not inferior to that obtained by age (0.728, 95% CI 0.649–0.797 vs. 0.800, 95% CI 0.727–0.861, P = 0.101) and to that obtained by the combination of multivessel CAD with diabetes (0.750; 95% CI 0.673–0.817, P = 0.635), and, furthermore, it was higher than that obtained by diabetes alone (0.620, 95% CI 0.538–0.698, P = 0.036).
Conclusion
Ruling out the presence of significant peripheral atherosclerosis should be routinely considered in patients with ACS showing VC at echocardiography.
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