Mitral and Aortic Annular Calcification Are Highly Associated With Systemic Calcified Atherosclerosis

Abstract

Background-Atherosclerosis has been implicated as a cause of valvular calcification. The aim of this study was to determine whether atherosclerotic calcification in multiple vascular areas is significantly associated with aortic or mitral annular calcification independent of traditional risk factors. Methods and Results-A total of 1242 consecutive asymptomatic patients free of clinical coronary heart disease were studied by electron-beam computed tomography for the extent of calcium due to atherosclerosis in 5 distinct vascular beds and calcium in the aortic and mitral annuli. Nearly 24% had calcium in the aortic annulus, whereas 8% were found to have mitral annular calcification. Age and a history of hypertension were the only traditional cardiovascular risk factors that were independently associated with prevalent calcification in the aortic and mitral annuli. After adjustment for age, gender, and cardiovascular disease risk factors, subjects with calcium in the thoracic aorta had the highest odds for the presence of aortic annular calcium (ORϭ3.9, PϽ0.01), whereas those with calcium in the abdominal aorta had the highest odds for mitral annular calcification (ORϭ5.1, Pϭ0.01). Standardized increases in calcium in the abdominal aorta (ORϭ2.0, PϽ0.01) and iliacs (ORϭ1.8, Pϭ0.01) were significantly associated with calcium in the aortic annulus after adjustment for the extent of calcium in the other vascular beds, whereas the thoracic aorta was significantly associated (ORϭ1.4, Pϭ0.02) with calcium in the mitral annulus. Conclusions-This

Correlation between coronary and valve calcification: Review of current evidence

“…Age is an independent predictor of AVC presence in most studies 94,95,96,97,98,99,100,101 , but does not appear to be predictive of progression , . Prevalence rates between AVC and CAC grew more similar with age in asymptomatic subjects, with CAC appearing around seven years before AVC .…”

“…there is little correlation between calcification presence in the two valves; in symptomatic patients and Japanese women with osteoporosis there was no correlation 63,64 although in asymptomatic subjects there was moderate correlation between calcification of the two annuli 65 . Nevertheless, studies of asymptomatic subjects show a good correlation between calcification of the combined annuli and most vascular beds 66,67 , with calcification of the thoracic aorta being the strongest correlation 68 , while renal artery calcification presence appears to be associated with AVC but not with MAC 69 .…”

“…Nevertheless, studies of asymptomatic subjects show a good correlation between calcification of the combined annuli and most vascular beds 66,67 , with calcification of the thoracic aorta being the strongest correlation 68 , while renal artery calcification presence appears to be associated with AVC but not with MAC 69 . In asymptomatic subjects, aortic valve calcification is more prevalent than MAC, with incidence up to three times higher 70,71 , while in symptomatic patients there were almost equal numbers with MAC and AVC…”

“…With respect to calcification of the aortic root, one study found that CAC was a weak predictor, with tAC presence having the highest odds ratio 86 . AVC scores increased faster with higher baseline AVC score, showing that calcium begets calcium in the aortic valve as well as arteries 87 .…”

“…extensive CAC does not always imply valve calcification, however; in a small study 5% of patients with a CAC score of >400 had no cardiac calcification 74 . Few of these studies looked at conventional CV risk factors, although there was always a positive correlation between age and cardiac calcium scores 75,76,77,78 ; only hypertension was significantly associated with calcification of both annuli in asymptomatic subjects 79 , while in symptomatic patients, diabetes and hypertension were associated with combined valve calcification 80 .…”