Background:
Coronary artery calcification (CAC) is a strong predictor of cardiovascular events. We aimed to evaluate the prognostic significance of CAC detected by chest CT scan (CT) in heart failure (HF) with preserved ejection fraction (HFpEF) patients (pts) in the absence of coronary artery disease history (CAD Hx).
Methods:
In this retrospective cohort, we queried our HF data base and identified HFpEF pts diagnosed in 2006 and followed till June 2015. Subjects were divided into 3 groups: group 1 pts have CAD Hx; group 2 pts have no CAD Hx but CAC on CT; group 3 pts have neither CAD Hx nor CAC. Primary outcome was cardiovascular disease (CVD) mortality. Optimal medical therapy (OMT) for CAD pts defined as aspirin, statins, and ACE inhibitors/ARBs.
Results:
We identified 249 eligible pts. Mean age was 72.1 ± 13.4 years. Women constituted 56.6%. CAD Hx was detected in 124 pts (group 1), while 55 pts and 70 pts represented group 2 and 3, respectively. The CVD mortality rate for group 1 and 2 was 25% and 23.6% , respectively, while for group 3 it was 7.1% (p=0.008 after adjustment for age, sex, BMI, hypertension, diabetes, atrial fibrillation, and other covariates). Only 30.6% of CAC pts were on OMT, as opposed to 47.6% in group1 and 25% in group 3(p=0.002).
Conclusions:
In HFpEF pts, CT-detected CAC is independent predictor of mortality despite the absence of CAD Hx. Accordingly, screening for CT-detected CAC in HFpEF pts may be a beneficial tool for detecting those at risk for CVD mortality and optimizing medical therapy.