Association of mitral annulus calcification, aortic valve calcification with carotid intima media thickness

a b s t r a c tObjective: Degenerative aortic stenosis shows similarities with atherosclerosis. To confirm the hypothesis that aortic stenosis is an "atherosclerosis-like" disease, we investigated the association between degenerative aortic stenosis and atherosclerosis of carotid arteries. Methods: We studied 270 consecutive patients, 135 with degenerative aortic stenosis (trans-aortic peak velocity ! 2 m/sec) and other 135 subjects without aortic valve disease. All patients underwent echocardiography and ultrasound scan of the supra-aortic trunks to assess the presence of plaque and/or intima-media thickening (IMT). Results: Atherosclerosis of carotid arteries (IMT and plaque) was significantly more frequent in patients with aortic stenosis than in controls (95.5% vs. 66.6%, p < 0.0001). The same result was confirmed as concerns carotid plaques (69.6% vs. 42.2%, p < 0.0001). In addition, there was a significant association between aortic stenosis and degenerative carotid plaque (OR ¼ 3.13; 95% C.I. ¼ 1.90e5.17). Thus the presence of a linear correlation between the trans-aortic peak velocity of the cases and the thickness of the plaques and IMT was evaluated by calculating the coefficient of correlation (R ¼ 0.15 for plaque and R ¼ 0.53 for IMT). Conclusions: The presence of carotid atherosclerosis is associated with degenerative aortic stenosis and the severity of aortic stenosis corresponds to an increase of the thickness of plaque and IMT. This relationship is quite new. Our result strengthens the pathogenetic hypothesis "atherosclerosis-like" of degenerative aortic stenosis and suggest the ultrasound scan as a non invasive method for risk stratification in patient with aortic stenosis, with therapeutic implications especially for higher risk subgroups.

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“…According to other studies the value of IMT also increases linearly with the extent of valvular calcification [12].…”

Section: Discussionmentioning

confidence: 99%

Association between asymptomatic carotid atherosclerosis and degenerative aortic stenosis

et al. 2012

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“…There are few studies which investigated the relationship between fetuin-A and MAC. Sgorbini et al (28) observed a negative correlation between MAC and fetuin-A levels in a group of CAD patients with normal or mildly impaired renal functions. Supporting these results Ix et al (30) revealed a significant, negative association between MAC and serum fetuin-A level.…”

Section: Discussionmentioning

confidence: 97%

“…There are few studies investigating the association between MAC and CIMT. Sgorboni et al (28) showed that patients with MAC had higher CIMT measurements. In this pres- CIMT -carotid intima-media thickness, EDVR -endothelium-dependent vasodilatory response, hsCRP -high-sensitive C-reactive protein ent study MAC group had statistically higher levels of CIMT measurements than the control group.…”

Section: Discussionmentioning

confidence: 99%

Association of mitral annular calcification with endothelial dysfunction, carotid intima-media thickness and serum fetuin-A: an observational study

Zıyrek¹,

Tayyareci²,

Yurdakul³

et al. 2013

Anadolu Kardiyol Derg

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Objective: Mitral annular calcification (MAC) is characterized by degenerative calcification of the mitral valve annulus. Atherosclerosis plays role in progression of MAC. Fetuin A is the inhibitor of pathological calcification. In the present study, we investigated the relationship between MAC and fetuin A with carotid intima media thickness (CIMT) and endothelial dysfunction. Methods: In this observational cross-sectional study, 40 patients with documented MAC on transthoracic echocardiography (TTE) and 40 without MAC were included. All patients had coronary artery disease (CAD). Endothelial functions were assessed by brachial artery Doppler ultrasound (USG) and carotid artery Doppler USG. Serum fetuin-A level was also measured. Linear regression analysis and receiver operator curve (ROC) analysis were performed. Results: Endothelial derived vasodilatory response (EDVR) was significantly decreased and CIMT value was increased in MAC group. There was a strong positive correlation between EDVR and serum fetuin-A value. There was a strong negative correlation between CIMT and EDVR, moderately negative correlation between CIMT and serum fetuin-A level. Simple linear regression analysis revealed that CIMT (β=0.367, p=0.001) and serum fetuin-A level (β=-0.291, p=0.009) were independent factors associated with MAC. The area under the curve (AUC) for serum fetuin-A level was 0.731 (95% 0.620-0.824) and AUC for CIMT was 0.724 (95% CI 0.613-0.818). Conclusion: We observed that MAC is closely related with CIMT and serum fetuin-A level. Serum fetuin-A and CIMT can be used as independent markers in the diagnosis of MAC. We suggest that MAC can be used as an early determinant of CAD. (Anadolu Kardiyol Derg 2013; 13: 752-8) Key words: Endothelial function, fetuin-A, mitral annular calcification, regression analysis, diagnostic accuracy, specificity, sensitivity Original Investigation Özgün Araşt›rma 752ÖZET Amaç: Mitral anüler kalsifikasyon (MAK), mitral kapak anulusunun dejeneratif kalsifikasyonu ile karakterize bir hastalıktır. MAK gelişiminde aterosklerotik mekanizmaların rol oynadığı düşünülmektedir. Fetuin-A, patolojik kalsifikasyonun inhibitörlerindendir. Çalışmamızda; MAK ile, endotel fonksiyon bozukluğu, karotis intima media kalınlığı (KİMK) ve serum fetuin-A düzeyleri arasındaki ilişkiyi inceledik. Yöntemler: Bu gözlemsel, kesitsel çalışmaya, transtorasik ekokardiyografide MAK saptanan 40 hasta ile saptanmayan 40 hasta dahil edildi. Tüm hastalar koroner arter hastası idi. Endotel fonksiyonları brakiyal arter ultrasonografisi (USG), karotis arter Doppler USG ile değerlendirildi. Hastaların Fetuin A düzeyi ölçüldü. Lineer regresyon analizi ve "ROC" analizi ile istatistiki değerlendirmeler yapıldı. Bulgular: MAK grubundaki ortalama endotele bağımlı vazodilatasyon yanıtı (EBVY) kontrol grubuna göre anlamlı olarak azalmış, ortalama karotis intima media kalınlığı ise artmıştı. EBVY ile serum fetuin-A düzeyi arasında güçlü derecede pozitif korelasyon saptandı. KİMK ile EBVY arasında güçlü derecede negatif korelasyo...

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“…However, there have been reports of an association between mitral and aortic valve calcification and generalized atherosclerosis, mainly in elderly patients. 7,8 In these patients, carotid intima media thickness (cIMT) increases in parallel with the degree of valvular calcification score. 7 Patients undergoing heart valve surgery may also have a high prevalence of vascular risk factors (eg, hypertension, hyperlipidemia, diabetes mellitus, and smoking).…”

Section: Carotid Artery and Heart Valve Disease: A Common Occurrence?mentioning

confidence: 99%

“…7,8 In these patients, carotid intima media thickness (cIMT) increases in parallel with the degree of valvular calcification score. 7 Patients undergoing heart valve surgery may also have a high prevalence of vascular risk factors (eg, hypertension, hyperlipidemia, diabetes mellitus, and smoking). 9 Extrapolating from a population-based study of patients with carotid artery occlusion, 3 the vast majority of cardiovascular patients had at least 1 vascular risk factor.…”

Section: Carotid Artery and Heart Valve Disease: A Common Occurrence?mentioning

confidence: 99%

Carotid Artery Stenosis and Heart Valve Surgery: A Complex Scenario

Paraskevas

Mikhailidis

2011

Angiology

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Anselmi et al in this issue of Angiology report a 26.4% incidence of >50% concomitant asymptomatic carotid artery stenosis in a cohort of >1000 patients undergoing isolated heart valve surgery. 1 They suggest that combined carotid endarterectomy and heart valve surgery is a safe option to reduce postoperative stroke or transient ischemic attack (TIA) episodes in these patients. 1 Some additional comments may be of interest.

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Association of mitral annulus calcification, aortic valve calcification with carotid intima media thickness

Cited by 16 publications

References 31 publications

Association between asymptomatic carotid atherosclerosis and degenerative aortic stenosis

Association between asymptomatic carotid atherosclerosis and degenerative aortic stenosis

Association of mitral annular calcification with endothelial dysfunction, carotid intima-media thickness and serum fetuin-A: an observational study

Carotid Artery Stenosis and Heart Valve Surgery: A Complex Scenario

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