The Association between Heart Valve Calcification and Poor Outcome among Patients with Heart Failure

Background: Calcium deposits on heart valves are considered a local manifestation of atherosclerosis and are associated with poor cardiovascular outcome. The clinical significance of total heart valve calcification (THVC), as assessed by echocardiography among heart failure (HF) patients, is not known. Our aim was to assess associations of THVC with mortality and hospital admissions in patients with HF.

Methods: Medical records of all patients who were under ambulatory surveillance at our HF clinic during 2011-2017 were reviewed. Calcifications in the aortic valve, aortic root and mitral valve were summed into a THVC score (0-3). Patients were divided into four groups according to THVC. The primary end-points were all-cause mortality and more than one hospitalization due to HF.

Results: Included were 1,138 patients (mean age 71.9±13, 62% male). Considering the patients with no calcification (THVC-0) as the reference group yielded adjusted hazard ratios for all-cause death that increased in an independent graded association with additional valve calcifications (HR=1.6, 95%CI=1.3-2.0; HR=2.1, 95%CI=1.7-2.6; HR=2.2, 95%CI=1.4-3.2 for patients with THVC of 1, 2 and 3, respectively, p<0.01). A higher THVC was also associated with significantly higher risk for heart failure hospitalizations: 1.6 (95% CI 1.2-2.2), 1.6 (95% CI 1.2-2.2) and 2.5 (95% CI 1.3-5.1) for THVC of 1, 2 and 3, respectively, p

Conclusion: We found an independent graded association between elevated THVC score and the risk of death and HF hospitalizations among ambulatory HF patients. The THVC score may contribute to the risk stratification of patients with HF.