Ultrasound cardiac calcium assessment

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Heart Online First, published on April 12, 2014 as 10.1136/heartjnl-2014-305855 PostScript

CORRESPONDENCE

Ultrasound cardiac calcium assessment Dear Editor; We congratulate the authors Kalsch et al, for their interesting paper1 which demonstrates that aortic valve calcification (AVC) by CT builds on Framingham score for risk stratification of future cardiovascular events. These are important data for preventive strategies, obtained in a wide and prospective study of healthy asymptomatics. In the discussion, the authors state that “detection of degenerative aortic valve disease by assessing the prevalence of AVC can easily be performed by echocardiography” and that both echo and CT “provide a high degree of accuracy and reproducibility of AVC, with a higher degree of sensitivity provided by echocardiography but with less specificity than cardiac CT”. This difference can be understood in light of the known inability of ultrasound to differentiate between severe fibrosis and calcification, which inflates sensitivity but increases false-positive rate as long as calcium is the only endpoint; we want to stress that this ‘limitation’ might also represent an advantage of ultrasound compared with CT since fibrosis may also represent a marker of disease that is worth to detect.

In a very recent paper from our group, too recent to be cited in the current paper, entitled “Aortic valve sclerosis as a marker of coronary artery atherosclerosis; a multicenter study of a large population with a low prevalence of coronary artery disease”, Rossi et al2 demonstrated that the presence of AV sclerosis/calcification at echocardiography gives a patient 20 times (OR 21.8, 95% CI 6.6 to 71.9, p