Association of Annular Calcification and Aortic Valve Sclerosis With Brain Findings on Magnetic Resonance Imaging in Community Dwelling Older Adults

Abstract

Objective The objective of this study is to investigate the association of mitral annular calcification (MAC), aortic annular calcification (AAC), and aortic valve sclerosis (AVSc) with covert magnetic resonance imaging (MRI)-defined brain infarcts. Background Clinically silent brain infarcts defined by MRI are associated with increased risk of cognitive decline, dementia, and future overt stroke. Left sided cardiac valvular / annular calcifications are suspected as risk factors for clinical ischemic stroke. Methods 2,680 Cardiovascular Health Study participants without clinical history of stroke or transient ischemic attack underwent both brain MRI (1992–93) and echocardiography (1994–95). Results The mean age of the participants was 74.5 years ± 4.8 and 39.3% were men. The presence of any annular / valvular calcification (either MAC or AAC or AVSc), MAC alone, or AAC alone were significantly associated with a higher prevalence of covert brain infarcts in unadjusted analyses (p < 0.01 for all). In models adjusted for age, sex, race, body mass index, physical activity, creatinine, systolic blood pressure, total cholesterol, HDL-cholesterol, smoking, diabetes, coronary heart disease, and congestive heart failure, the presence of any annular / valve calcification remained associated with covert brain infarcts [RR 1.24 (95% CI 1.05, 1.47)]. The degree of annular / valvular calcification severity showed a direct relation with the presence of covert MRI findings. Conclusion Left-sided cardiac annular / valvular calcification are associated with covert MRI-defined brain infarcts. Further study is warranted to identify mechanisms and determine whether intervening on the progression of annular / valvular calcification could reduce the incidence of covert brain infarcts as well as the associated risk of cognitive impairment and future stroke.

Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

“…Two of the other 3 population-based studies did not reveal a significant association between mitral annular calcification and risk for ischemic stroke in adjusted analyses. 503,506 No association was observed among 568 patients assigned to placebo in an AF trial. 512 Mitral annular calcification is associated with cardiovascular risk factors and atherosclerosis in other vascular distributions.…”

“…Idiopathic calcification of the mitral valve is common in the general population [503][504][505][506][507][508] and is detected on ultrasonography in ≥10% of patients with TIA or ischemic stroke. 509, 510 The condition affects women more than men and is strongly associated with age.…”

“…508 The association between mitral annular calcification and risk for stroke has been examined in at least 4 population-based cohort studies. 503,506,508,511 All 4 excluded patients with a prior stroke. In the Framingham Heart Study, mitral annular calcification was associated with increased risk for all types of stroke during 8 years of observation (adjusted RR, 2.10; 95% CI, 1.24-3.57); however, only 14 of 22 outcome strokes were embolic, and some were associated with development of AF during follow-up.…”

CKD is associated with recurrent ischemia but not with hemorrhagic transformation in acute ischemic stroke patients

“…Rodriguez et al 19 revealed that left sided cardiac valvular calcifications were associated with covert MRI-defined brain infarcts. Vascular calcification is a well-known complication of CKD but results revealed no significant association between aortic valve calcification and CKD in this study.…”

Cardiological Aspects of Stroke Prevention

“…40, 41 Diseases of the aortic valve, including aortic regurgitation, stenosis, sclerosis, and annular calcification, do not appear to independently increase the risk of IS. 42 Valve replacement increases the risk of IS via thromboembolism and this risk is greater with mechanical than bioprosthetic valves. Most patients with mechanical valves should be treated with warfarin and aspirin, with a target INR of 2.0-3.0 for low-risk aortic valve patients, or of 2.5-3.5 for patients with additional risk factors or mitral valves.…”