Association 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

In Jeong Cho, Hyuk Jae Chang, Iksung Cho, Ran Heo, Sang Eun Lee, Chi Young Shim, Geu Ru Hong, Namsik Chung

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

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. δSBPstage2 and δSBPpeak 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, δSBPstage2 and δSBPpeak 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 mm3 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.

Original languageEnglish
Article numbere003131
JournalJournal of the American Heart Association
Volume5
Issue number4
DOIs
Publication statusPublished - 2016 Jan 1

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Thoracic Aorta
Aorta
Coronary Vessels
Exercise
Blood Pressure
Calcium
Thorax
Stroke
Tomography
Dyslipidemias
Proportional Hazards Models
Coronary Artery Disease
Cause of Death
Pathologic Constriction
Heart Failure

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

@article{f867f7762e6b489892ccf50014536070,
title = "Association 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",
abstract = "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. δSBPstage2 and δSBPpeak 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, δSBPstage2 and δSBPpeak 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 mm3 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.",
author = "Cho, {In Jeong} and Chang, {Hyuk Jae} and Iksung Cho and Ran Heo and Lee, {Sang Eun} and Shim, {Chi Young} and Hong, {Geu Ru} and Namsik Chung",
year = "2016",
month = "1",
day = "1",
doi = "10.1161/JAHA.115.003131",
language = "English",
volume = "5",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "4",

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TY - JOUR

T1 - Association of thoracic aorta calcium score with exercise blood pressure response and clinical outcomes in elderly individuals

T2 - Differential impact of aorta calcification compared with coronary artery calcification

AU - Cho, In Jeong

AU - Chang, Hyuk Jae

AU - Cho, Iksung

AU - Heo, Ran

AU - Lee, Sang Eun

AU - Shim, Chi Young

AU - Hong, Geu Ru

AU - Chung, Namsik

PY - 2016/1/1

Y1 - 2016/1/1

N2 - 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. δSBPstage2 and δSBPpeak 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, δSBPstage2 and δSBPpeak 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 mm3 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.

AB - 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. δSBPstage2 and δSBPpeak 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, δSBPstage2 and δSBPpeak 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 mm3 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.

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DO - 10.1161/JAHA.115.003131

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