Open AccessAssociation of Thoracic Aorta Calcium Score With Exercise Blood Pressure Response and Clinical Outcomes in Elderly Individuals: Differential Impact of Aorta Calcification Compared With Coronary Artery Calcification
Author(s) -
Cho InJeong,
Chang HyukJae,
Cho Iksung,
Heo Ran,
Lee SangEun,
Shim Chi Young,
Hong GeuRu,
Chung Namsik
Publication year - 2016
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.115.003131
Subject(s) - medicine , cardiology , coronary artery disease , quartile , blood pressure , hazard ratio , stroke (engine) , calcification , dyslipidemia , stenosis , confidence interval , disease , mechanical engineering , engineering
Background The structure of the aorta is considered to influence exercise systolic blood pressure ( SBP ) response, which, in turn, might impact upon adverse outcomes. The current study sought to investigate the relationship of aortic calcification and exercise SBP with adverse outcomes among elderly individuals. Methods and Results We retrospectively reviewed 702 elderly individuals (>65 years of age) without obstructive coronary artery disease ( CAD ; luminal stenosis <50%) who underwent coronary computed tomography ( CT ) and exercise treadmill testing. Δ SBP stage2 and Δ SBP peak were defined as the difference in systolic blood pressure ( SBP ) between rest and stage 2 or peak exercise, respectively. Thoracic aortic calcium score ( TACS ) and coronary artery calcium score ( CACS ) were measured using CT scanning procedures. The primary endpoints were defined as all‐cause death, admission for heart failure, obstructive CAD requiring coronary intervention, and stroke. In multivariable models, Δ SBP stage2 and Δ SBP peak were positively related with log ( TACS +1), even after adjusting for various clinical variables, baseline SBP , and CACS ( P <0.001). During a median follow‐up period of 65 months, there were 59 events (8.4%). In a multivariate Cox regression model, independent predictors for all events were age (hazard ratio [ HR ], 1.12; 95% CI , 1.05–1.19; P <0.001), dyslipidemia ( HR , 1.96; 95% CI , 1.14–3.37; P =0.015), and the 4th quartile of TACS ( HR , 1.24; 95% CI , 1.03–1.49; P =0.024). Among individual events, the 4th quartile of TACS was the only independent predictor for stroke ( HR , 2.15; 95% CI , 1.09–5.13; P =0.044), whereas CACS ≥400 mm 3 was an independent predictor for obstructive CAD requiring intervention ( HR , 7.04; 95% CI , 1.58–31.36; P =0.010). Conclusions Aortic calcification was related to SBP response during exercise and was an independent predictor for outcomes, especially stroke, regardless of resting SBP or CACS .