Relationship between Aortic Knob Calcification and Coronary Artery Calcium Scores Among Patients with Stable Angina Pectoris
Ahmet Karaduman1
, Cemalettin Yılmaz2, İsmail Balaban1, Mustafa Ferhat Keten1, Muzaffer Kahyaoğlu1, Elnur Alizade1, Çetin Geçmen1
1Department of Cardiology, Kartal High Specialization Training and Research Hospital, İstanbul, Türkiye
2Department of Cardiology, Muş State Hospital, Muş, Türkiye
Keywords: Aortic knob calcification; cardiac computed tomography; chest X-ray; coronary artery calcium score.
Abstract
Objectives: The deposition of calcium in the vascular bed can reflect the presence of atherosclerotic lesions, and aortic knob calcification (AKC) has been shown to correlate with a heightened risk of cardiovascular disease (CVD) events. This retrospective research was undertaken with the aim of evaluating the relationship between AKC and the coronary artery calcium score (CACS) by chest X-ray and investigating the possibility of using AKC to predict the risk of CVD. We hypothesized that AKC would be detected more frequently on chest X-rays among patients with severe CACS values.
Methods: The study included 282 consecutive patients diagnosed with stable angina pectoris (SAP) who had presented to our cardiology outpatient clinic between 2018 and 2020 and underwent cardiac computed tomography and chest X-ray. Those whose chest X-rays revealed small spots or singular areas of fine calcification were considered to have AKC. CACS values were classified according to the Agatston score and CACS severity was defined as none-mild (<100) or moderate-severe (>100).
Results: The mean age of the 282 enrolled patients was 47.5±11.3 years and 169 (59.9%) of the patients were male. CACS values of >100 signifying moderate-severe risk were observed more commonly among patients with diabetes mellitus, hypertension (HT), older age, and smoking habits (p<0.001). Thirty-five patients (12.4%) had AKC on a chest X-ray. Patients with AKC were more likely to be categorized in the moderate-high CACS severity group than those without AKC (p<0.001). Logistic regression analysis demonstrated that HT (odds ratio [OR]: 4.413; 95% confidence interval [CI]: 1.733–11.240; p=0.002) and AKC (OR: 5.619; 95% CI: 2.280–13.848; p<0.001) were independent predictors of moderate-severe CACS values.
Conclusion: It is important to establish the risk of CVD in patients with SAP using simple and non-invasive methods. Our study showed that the presence of AKC on chest X-ray is associated with higher CACS values in patients presenting with SAP. Therefore, AKC may be used more frequently for the evaluation of the risk of CVD.
Cite This Article: Karaduman A, Yılmaz C, Balaban İ, Keten MF, Kahyaoğlu M, Alizade E, Geçmen Ç. Relationship between Aortic Knob Calcification and Coronary Artery Calcium Scores Among Patients with Stable Angina Pectoris. Koşuyolu Heart J 2025;28(2):54–59