M itral annulus calcification (MAC) is a common finding in the elderly. A rare manifestation of MAC is liquefaction necrosis that can be mistaken for a tumor or an abscess. Because its course is most often benign, a correct diagnosis is imperative to avoid unnecessary workup or treatment.
CaseA 76-year-old woman with history of hypertension and dyslipidemia presented with chest pain and elevated cardiac enzymes. A coronary angiogram revealed no significant coronary artery disease.Echocardiogram ( Figure 1) revealed a large, solid mass within the atrioventricular groove and the lateral wall of the left ventricle. There was moderate calcification of the mitral valve annulus. Computed tomography scan of the chest (Figure 2) revealed a soft tissue density inseparable from the region of the mitral valve and the left ventricular wall. Cardiac magnetic resonance (CMR) showed a large mass involving the basal lateral wall near the atrioventricular groove, extending into the left atrium ( Figure 3A and 3B). The mass was slightly hyperintense on T1 (Figure 4) and hypointense on T2 imaging ( Figure 5). The mass was homogenous on delayed enhancement with a bright ring (Figure 6), the characteristics were not changed with fat saturation, and it was avascular by perfusion ( Figure 7). The patient was discharged from the hospital with a scheduled outpatient workup to continue.The patient returned 2 weeks later, however, with an acute stroke in Ͼ1 arterial distribution, and workup for an embolic source commenced. A CMR ( Figure 3C and 3D) revealed no left ventricular thrombus; the mass increased in size and changed in consistency, appearing semisolid.The patient underwent a left thoracotomy for a biopsy, which revealed a thick whitish fluid (Figure 8) thought to be
Background
Aortic distensibility (AD) is an important determinant of cardiovascular (CV) morbidity and mortality. There is scant data on the association between AD measured within the descending thoracic aorta and CV outcomes.
Objective
We evaluated the association of AD at the descending thoracic aorta (AD
desc
) with the primary outcome of all-cause mortality, myocardial infarction (MI), stroke or coronary revascularization in patients referred for a cardiovascular magnetic resonance (CMR) study.
Methods
928 consecutive patients [(mean age 60 ± 17; 33% with prior cardiovascular disease (CVD))] were evaluated. AD
desc
was measured at the cross-section of the descending thoracic aorta in the 4-chamber view (via steady-state free precession [SSFP] cine sequences) and was grouped into quintiles (with the 1st quintile corresponding to the least AD, i.e., the stiffest aorta). Cox proportional-hazards regression analysis were performed for the primary outcome.
Results
A total of 315 patients (34%) experienced the primary outcome during a median (25% IQR, 75% IQR) follow-up of 5.0 (0.56, 9.3) years. A decreased AD was significantly associated with hypertension, diabetes, renal disease, and dyslipidemia (p <0.0001). A primary outcome occurred in 43% of patients with AD
desc
≤ median compared to 25% with AD
desc
> median, p <0.0001, and in 44% of patients with AD
desc
in the 1st quintile compared to 31% with AD
desc
in the other quintiles (p = 0.0004). Event free survival was incrementally reduced amongst quintiles (p <0.0001). However, AD
desc
≤ median was not an independent predictor of the primary endpoint after multivariable adjustment in the overall population [adjusted HR 1.09 (95% CI:0.82–1.45), p = 0.518] or in the subgroup analysis of patients with or without prior CVD.
Conclusion
In this real-world cohort of 928 patients referred for CMR, AD
desc
is not an independent predictor of CV outcomes.
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