Atherosclerosis 213 (2010) 166–172 Contents lists available at ScienceDirect Atherosclerosis journal homepage: www.elsevier.com/locate/atherosclerosis Combined presence of aortic valve calcification and mitral annular calcification as a marker of the extent and vulnerable characteristics of coronary artery plaque assessed by 64-multidetector computed tomography Hiroto Utsunomiya a , Hideya Yamamoto a,∗ , Eiji Kunita a , Toshiro Kitagawa a , Norihiko Ohashi a , Toshiharu Oka a , Ryo Yamazato a , Jun Horiguchi b , Yasuki Kihara a a Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan b Department of Clinical Radiology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan article info Article history: Received 22 June 2010 Received in revised form 13 August 2010 Accepted 18 August 2010 Available online 24 September 2010 Keywords: Aortic valve calcification Computed tomography Mitral annular calcification Coronary artery plaque Vulnerability abstract Objective: We examined the association of aortic valve calcification (AVC) and mitral annular calcification (MAC) to coronary atherosclerosis using 64-multidetector computed tomography (MDCT). Background: Valvular calcification is considered a manifestation of atherosclerosis. The impact of multiple heart valve calcium deposits on the distribution and characteristics of coronary plaque is unknown. Methods: We evaluated 322 patients referred for 64-MDCT, and assessed valvular calcification and the extent of calcified (CAP), mixed (MCAP), and noncalcified coronary atherosclerotic plaque (NCAP) in accordance with the 17-coronary segments model. We assessed the vulnerable characteristics of coronary plaque with positive remodeling, low-density plaque (CT density ≤38 Hounsfield units), and the presence of adjacent spotty calcification. Results: In 49 patients with both AVC and MAC, the segment numbers of CAP and MCAP were larger than in those with a lack of valvular calcification and an isolated AVC (p < 0.001 for both). Multivariate analyses revealed that a combined presence of AVC and MAC was independently associated with the presence (odds ratio [OR] 9.36, 95% confidence interval [95%CI] 1.55–56.53, p = 0.015) and extent (ˇ-estimate 1.86, p < 0.001) of overall coronary plaque. When stratified by plaque composition, it was associated with the extent of CAP (ˇ-estimate 1.77, p < 0.001) and MCAP (ˇ-estimate 1.04, p < 0.001), but not with NCAP. Moreover, it was also related to the presence of coronary plaque with all three vulnerable characteristics (OR 4.87, 95%CI 1.85–12.83, p = 0.001). Conclusion: The combined presence of AVC and MAC is highly associated with the presence, extent, and vulnerable characteristics of coronary plaque identified by 64-MDCT. © 2010 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Valvular calcification is generally considered a manifestation of atherosclerosis. Particularly, aortic valve calcification (AVC) and mitral annular calcification (MAC) were reported to be indepen- dently associated with both cardiovascular risk factors [1] and coronary artery calcification (CAC) [2,3]. Recent epidemiological studies have also demonstrated that the combined presence of Abbreviations: AVC, aortic valve calcification; CAC, coronary artery calcification; CAD, coronary artery disease; CAP, calcified coronary atherosclerotic plaque; Ccr, creatinine clearance; HU, Hounsfield units; MAC, mitral annular calcification; MCAP, mixed coronary atherosclerotic plaque; MDCT, multidetector computed tomogra- phy; NCAP, noncalcified coronary atherosclerotic plaque. ∗ Corresponding author. Tel.: +81 82 257 5540; fax: +81 82 257 1569. E-mail address: hideyayama@hiroshima-u.ac.jp (H. Yamamoto). AVC and MAC is independent of and incremental to traditional risk assessment for the prediction of cardiovascular events, and is more strongly associated with cardiovascular mortality than is AVC or MAC alone [4]. Recent advances in contrast-enhanced data acquisition using multidetector computed tomography (MDCT) enabled the detec- tion of calcified coronary atherosclerotic plaque (CAP), mixed coronary atherosclerotic plaque (MCAP), and noncalcified coro- nary atherosclerotic plaque (NCAP), which was in good agreement with intravascular ultrasound [5,6]. Furthermore, 64-MDCT char- acterizes coronary plaque in terms of vascular positive remodeling, lipid-rich plaque, and adjacent spotty calcium, which may relate to the fact that vulnerable plaque is prone to rupture with subsequent coronary events [7,8]. Although AVC and MAC are believed to be associated with over- all coronary plaque burden using invasive coronary angiography or noncontrast-enhanced CT [2,9], the impact of multiple heart valve 0021-9150/$ – see front matter © 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.atherosclerosis.2010.08.070