Clinical Research in Cardiology

, Volume 108, Issue 2, pp 194–202 | Cite as

Echocardiographic calcification score in patients with low/intermediate cardiovascular risk

  • Kristof HirschbergEmail author
  • Manuel Reinhart
  • Derliz Mereles
  • Lorenz Uhlmann
  • Florian André
  • Johannes Riffel
  • Marco Ochs
  • Hugo A. Katus
Original Paper



Calcification of aortic valve and mitral annulus is associated with cardiovascular risk factors, morbidity and mortality. Assessment of cardiac calcification with echocardiography is feasible, however, only few structured scoring systems have been established so far with limited prognostic data. This study aimed to evaluate an echocardiographic calcification score (echo-CCS) in patients with low/intermediate cardiovascular risk.


Digitally stored echocardiography studies of 151 patients (median age 64, 49.7% male) from February 2008 to December 2009 were retrospectively reviewed for calcifications of the aortic valve, aortic root, mitral annulus, papillary muscles and ventricular septum. A calcification score ranging from 0 to 5 was assigned to every patient and its relation to computed tomography calcium score, coronary stenosis and ESC SCORE was assessed. Follow-up data were collected from 149 patients (98.7%) with a median of 6.2 years. Logistic regression and Kaplan–Meier analysis were performed to assess the association of the echo-CCS with significant coronary artery disease (≥ 50% stenosis) and risk for cardiac events and all-cause mortality.


An association of the echo-CCS with the ESC SCORE (ρ = 0.5; p < 0.001) and a good correlation of the echo-CCS with the Agatston score (ρ = 0.73; p < 0.001) can be observed. Univariate regressions revealed that echo-CCS is a significant predictor for cardiac events [OR = 5.1 (CI: 1.7–15.0); p = 0.003], coronary intervention [OR = 2.8 (CI: 1.3–5.7); p = 0.006], hospitalisation for cardiac symptoms [OR = 2.0 (CI: 1.2–3.4); p = 0.007], all-cause mortality [OR = 2.6 (CI: 1.3–5.5); p = 0.01] and significant CAD [OR = 3.2 (CI: 1.9–5.4); p < 0.001].


We demonstrated the prevalence of an easily obtainable, radiation-free calcification score in patients with low/intermediate cardiovascular risk. The strong association with CT-calcium scoring may evoke its potential as an alternative method in CV risk assessment.


Echocardiography Computed tomography Calcification Score Coronary artery disease 



There was no funding for this work.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Internal Medicine III, Cardiology, Angiology and PneumologyUniversity of HeidelbergHeidelbergGermany
  2. 2.Institute of Medical Biometry and InformaticsUniversity of HeidelbergHeidelbergGermany

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