European Heart Journal Advance Access originally published online on May 8, 2009
European Heart Journal 2009 30(16):2054-2061; doi:10.1093/eurheartj/ehp158
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Association of fetuin-A levels with the progression of aortic valve calcification in non-dialyzed patients
1 Department for Cardiology, Pulmonology, and Vascular Medicine, University Hospital RTWH Aachen, RWTH University Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany
2 Department of Diagnostic Radiology, University Hospital RTWH Aachen, RWTH University Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany
3 Institute of Medical Statistics, University Hospital RTWH Aachen, RWTH University Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany
4 Department of Nephrology and Clinical Immunology, and University Hospital RTWH Aachen, RWTH University Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany
5 IZKF Biomat, University Hospital RTWH Aachen, RWTH University Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany
Received 23 October 2008; revised 4 March 2009; accepted 20 March 2009; online publish-ahead-of-print 8 May 2009.
* Corresponding author. Tel: +49 241 803 5443, Fax: +49 241 808 2545, Email: rkoos{at}ukaachen.de
Aims: Fetuin-A has been identified as a potent circulating inhibitor of ectopic calcification. We investigated the relationship between baseline fetuin-A serum levels and the rate of progression of aortic valve calcification (AVC) in non-dialyzed patients with aortic valve disease (AVD).
Methods and results: Seventy-seven patients (mean age 70 ± 8 years) with echocardiographically proven AVD were collected. In all patients, serum fetuin-A levels, creatinine, calcium, lipid parameters, and C-reactive protein were measured at baseline. For quantification of AVC progression, all patients underwent multislice spiral computed tomography examinations at baseline and after a mean follow-up of 12.6 ± 1.4 months (range 7–18 months). In a multifactorial analysis of covariance including fetuin-A levels, baseline AVC score, the covariables sex, age, body mass index, C-reactive protein, glomerular filtration rate, serum lipids, diabetes, smoking status, and hypertension, only serum fetuin-A levels significantly predict the progression of AVC (P < 0.001). Post hoc analysis demonstrated that patients with baseline fetuin-A levels lower than the median of the cohort (0.72 g/L) showed a significantly higher increase of AVC scores (34.6 ± 31.4%) than patients with fetuin-A levels larger than the median (10.0 ± 11.2%, P < 0.001) despite comparable baseline AVC scores. In addition, fetuin-A levels were associated with major adverse clinical events (MACE; P = 0.03).
Conclusion: Serum levels of the calcification inhibitor fetuin-A are associated with the progression of AVC and MACE, independent of the renal function and inflammation.
Key Words: Aortic valve stenosis • Calcification • Multi-slice CT
The first two authors contributed equally to the study.