Echographic-quantified severity of mitral anulus calcification: Prognostic correlation to related hemodynamic, valvular, rhythm, and conduction abnormalities

Mellino, M.; Salcedo, Ernesto E.; Lever, Harry M.; Vasudevan, Gopalan; Kramer, John

doi:10.1016/0002-8703(82)90495-1

Cited by 56 publications

(33 citation statements)

References 19 publications

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“…MAC has been associated with age, cardiovascular diseases, stroke, and congestive heart failure (5,(7)(8)(9)(10)(11). Although the mechanism of MAC is not clearly understood, its predictive value in atherosclerosis is supported by several studies (22)(23)(24).…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

“…It has been demonstrated that MAC is associated with atherosclerotic risk factors (4). MAC is also correlated with age, infective endocarditis, cardiovascular disease, stroke, and congestive heart failure (5)(6)(7)(8)(9)(10)(11).…”

Section: Introductionmentioning

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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“…Our MAC criterium was an intense echo-producing structure ≥ 5 mm (severe MAC) located at the junction of the atrioventricular groove and posterior mitral valve leaflet on the parasternal long axis and apical 4-chamber views. 8,9) Carotid artery duplex sonography was performed with a 5-10 MHz transducer (Sonoline Antares, Siemens, Germany) and a 7.5 MHz transducer (Toshiba SSA-270 A, Japan). Carotid arteries were examined bilaterally.…”

Section: Methodsmentioning

confidence: 99%

Association Between Mitral Annular Calcification and Stroke

et al. 2004

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SUMMARYIt remains controversial as to whether mitral annular calcification (MAC) is an independent predictor of stroke. The aim of this study was to investigate whether there is an association between the presence of MAC and stroke or whether MAC is one of the predictive factors of carotid atheroma and therefore is a secondary risk for stroke.Fifty-six patients who had MAC demonstrated by echocardiography underwent carotid artery duplex sonography and computed brain tomography with various causes were enrolled in the study. They were compared with 58 control patients without MAC. MAC was defined as a dense, localized, highly reflective area larger than 5 mm at the junction of the atrioventricular groove and posterior mitral valve leaflet. Carotid artery stenosis was defined as lumen diameter narrowing exceeding 60%. Cerebral ischemia was detected by spiral tomography and was classified as infarction and lacunae.A significant association was found between the presence of MAC and carotid atheroma (P = 0.011), MAC and hyperechogen plaque (P = 0.034), and MAC and stenosis (P = 0.008). There was an association between the presence of carotid atheroma and cerebral infarction (P = 0.007). Logistic regression analysis revealed hypertension and diabetes mellitus were independent risk factors (P = 0.030, P = 0.034, respectively) for developing carotid atheroma. MAC was an independent factor for carotid stenosis (P = 0.029).MAC may not be a significant causative factor for stroke, but may be a secondary risk factor. A significant association between the presence of MAC and carotid artery atherosclerotic disease may explain the high prevalence of stroke in patients with MAC. (Jpn Heart J 2004; 45: 999-1005)

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“…[44][45][46][47][48][49][50] However, the use of these methods is limited in DMS and gives little insight into the mitral inflow dynamics. Pressure gradient and MVA are the indexes used to assess stenosis severity.…”

Section: Diagnosismentioning

confidence: 99%

Degenerative Mitral Stenosis

et al. 2016

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Abstract-Degenerative mitral stenosis (DMS) is an important cause of mitral stenosis, developing secondary to severe mitral annular calcification. With the increase in life expectancy and improved access to health care, more patients with DMS are likely to be encountered in developed nations. These patients are generally elderly with multiple comorbidities and often are high-risk candidates for surgery. The mainstay of therapy in DMS patients is medical management with heart rate control and diuretic therapy. Surgical intervention might be delayed until symptoms are severely limiting and cannot be managed by medical therapy. Mitral valve surgery is also challenging in these patients because of the presence of extensive calcification. Hence, there is a need to develop an alternative percutaneous treatment approach for patients with DMS who are otherwise inoperable or at high risk for surgery. In this review, we summarize the available data on the epidemiology of DMS and diagnostic considerations and current treatment strategies for these patients.

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Echographic-quantified severity of mitral anulus calcification: Prognostic correlation to related hemodynamic, valvular, rhythm, and conduction abnormalities

Cited by 56 publications

References 19 publications

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

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

Association Between Mitral Annular Calcification and Stroke

Degenerative Mitral Stenosis

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