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Aortic valve calcification — Clinical Guidelines

Overview

Aortic valve calcification (AVC) is a common condition characterized by the deposition of calcium within the aortic valve, often associated with aging and cardiovascular risk factors. It can lead to aortic stenosis and increased cardiovascular morbidity and mortality 5.

Diagnosis

Key Diagnostic Criteria: Presence of calcium deposits on imaging studies, typically detected via echocardiography, multidetector-row computed tomography (MDCT), or digital tomosynthesis 4 6.

Recommended Tests:

- Echocardiography: Initial screening tool for AVC 4. - MDCT: For detailed quantification and visualization of calcification volume 4. - Digital Tomosynthesis: Alternative to chest radiography for detecting aortic arch calcification 6.

Grading: Use Agatston scoring for quantification in MDCT studies 4.

Management

First-Line Treatments:

- Lifestyle Modifications: Control of hypertension and hyperlipidemia 5. - Ambulatory Blood Pressure Monitoring: Manage hypertension effectively 5.

Adjunctive Treatments:

- Calcitonin: Investigated for mitigating calcification in bioprosthetic valves, though efficacy remains uncertain 2. - Diphosphonates: Inhibit calcium phosphate crystal formation and may prevent aortic calcification in vivo 15. - Alkali Citrates: Ex vivo studies suggest potential reduction in aortic calcification 9.

Special Populations

Elderly: Higher prevalence of AVC; ambulatory blood pressure monitoring is particularly relevant 5.

Comorbidities: Elevated serum phosphate levels are independent predictors of aortic calcification volume in non-hemodialysis patients 3. Low calcidiol levels correlate with increased risk of aortic calcification progression 7.

Key Recommendations

Utilize MDCT for detailed assessment and quantification of aortic valve calcification (Evidence: Moderate 4).

Monitor and manage ambulatory blood pressure in elderly patients to reduce AVC progression (Evidence: Moderate 5).

Consider serum phosphate levels as a predictive marker for aortic calcification in non-hemodialysis patients (Evidence: Moderate 3).

Evaluate calcidiol levels in patients at risk for aortic calcification progression (Evidence: Moderate 7).

Further investigate calcitonin and diphosphonate therapies for potential mitigation of aortic calcification in high-risk populations (Evidence: Weak 2 15).

References

1 Hu S, Qiu S, Wan B, Ruan L, Zhu L, Wang S et al.. Association Between Serum Uric Acid and Abdominal Aortic Calcification in Adults Aged 40 to 80 years: A Retrospective Cross-Sectional Study. Angiology 2025. link 2 Agathos EA, Tomos PI, Kostomitsopoulos N, Koutsoukos PG. Calcitonin as an anticalcification treatment for implantable biological tissues. Journal of cardiology 2019. link 3 Kinugasa M, Mori S, Takaya T, Ito T, Tanaka H, Satomi-Kobayashi S et al.. Serum phosphate is an independent predictor of the total aortic calcification volume in non-hemodialysis patients undergoing cardiovascular surgery. Journal of cardiology 2016. link 4 Mori S, Takaya T, Kinugasa M, Ito T, Takamine S, Fujiwara S et al.. Three-dimensional quantification and visualization of aortic calcification by multidetector-row computed tomography: a simple approach using a volume-rendering method. Atherosclerosis 2015. link 5 Iwata S, Russo C, Jin Z, Schwartz JE, Homma S, Elkind MS et al.. Higher ambulatory blood pressure is associated with aortic valve calcification in the elderly: a population-based study. Hypertension (Dallas, Tex. : 1979) 2013. link 6 Kim EY, Chung MJ, Choe YH, Lee KS. Digital tomosynthesis for aortic arch calcification evaluation: performance comparison with chest radiography with CT as the reference standard. Acta radiologica (Stockholm, Sweden : 1987) 2012. link 7 Naves-Díaz M, Cabezas-Rodríguez I, Barrio-Vázquez S, Fernández E, Díaz-López JB, Cannata-Andía JB. Low calcidiol levels and risk of progression of aortic calcification. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 2012. link 8 Nishi H, Mitsuno M, Ryomoto M, Miyamoto Y. Comprehensive approach for clamping severely calcified ascending aorta using computed tomography. Interactive cardiovascular and thoracic surgery 2010. link 9 Schick CH, Schwille PO. Studies on the reduction of aortic calcification by alkali citrates in an ex vivo tissue preparation in the rat. Arzneimittel-Forschung 1993. link 10 Reid JD, Andersen ME. Medial calcification (whitlockite) in the aorta. Atherosclerosis 1993. link90118-e) 11 Rokita E, Cichocki T, Divoux S, Gonsior B, Höfert M, Jarczyk L et al.. Calcification of the aortic wall in hypercalcemic rabbits. Experimental and toxicologic pathology : official journal of the Gesellschaft fur Toxikologische Pathologie 1992. link80217-4) 12 Susheela AK, Kharb P. Aortic calcification in chronic fluoride poisoning: biochemical and electronmicroscopic evidence. Experimental and molecular pathology 1990. link90025-9) 13 Pardini A, Fucci C, Manzato A, Alfieri O. Arterial cannulation and myocardial protection in severe diffuse aortic calcification. Journal of cardiac surgery 1989. link 14 Bonucci E, Sadun R. Dihydrotachysterol-induced aortic calcification. A histochemical and ultrastructural investigation. Clinical orthopaedics and related research 1975. link 15 Francis MD, Russell RG, Fleisch H. Diphosphonates inhibit formation of calcium phosphate crystals in vitro and pathological calcification in vivo. Science (New York, N.Y.) 1969. link

Aortic valve calcification