Mitral annular calcium detected by transthoracic echocardiography is a marker for high prevalence and severity of coronary artery disease in patients undergoing coronary angiography

Adler, Yehuda; Herz, Itzhak; Vaturi, Mordehay; Fusman, Renato; Shohat‐Zabarski, Ronit; Fink, Noam; Porter, Avital; Shapira, Yaron; Assali, Abid; Sagie, Alex

doi:10.1016/s0002-9149(98)00596-7

Cited by 111 publications

(69 citation statements)

References 27 publications

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“…The association of CAD and HT with MAC, as noted in the present study, is consistent with the findings of previous studies (11,30). However, there was no significant relationship between MAC and other traditional cardiovascular risk factors such as diabetes, hyperlipidemia, increased BMI and smoking.…”

Section: Discussionsupporting

confidence: 93%

Impaired heart rate variability in patients with mitral annular calcification: an observational study

Kurtoğlu¹,

Aktürk²,

Korkmaz³

et al. 2013

Anadolu Kardiyol Derg

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Objective: The aim of the present study was to study time indices of heart rate variability (HRV) in patients with mitral annular calcification (MAC). Methods: A cross-sectional observational study was performed. Fifty patients with echocardiographic evidence of MAC and 50 age-and gender-matched control subjects without echocardiographic evidence of MAC were included. All the study participants underwent 2-dimensional echocardiographic examinations and 24-hour Holter monitoring for HRV analysis. Student-t, Mann-Whitney U and Chi-square tests were used for statistical analysis. Results: Hypertension and coronary artery disease were more common in the MAC group than in the control group. All HRV parameters including mean RR interval, SDNN, SDANN, SDNN index, pNN50 and RMSSD were reduced in the MAC group when compared with the control group (p<0.05 for all). In hypertensive subgroup, all HRV parameters except mean RR interval were diminished in patients with MAC when compared with those without MAC (p<0.05 for all). In non-hypertensive subgroup, all HRV parameters were also diminished in patients with MAC when compared with those without MAC. In the subgroup of patients with coronary artery disease, patients had lower HRV parameters except mean RR interval, pNN50 and RMSSD in comparison to those without MAC (p<0.05 for all). In the subgroup of patients without coronary artery disease, all HRV parameters were depressed in patients with MAC in comparison to those without MAC (p<0.05 for all). Conclusion: Our findings indicate that MAC was associated with reduced heart rate variability which possibly reflects decreased parasympathetic tone with a predominant activity of the sympathetic tone. (Anadolu Kardiyol Derg 2013; 13: 668-74) Key words: Mitral annular calcification, heart rate variability, autonomic dysfunction Original Investigation Özgün Araşt›rma 668ÖZET Amaç: Çalışmanın amacı mitral annüler kalsifikasyonu (MAK) olan hastalarda kalp hızı değişkenliği (KHD) parametrelerini incelemektir. Yöntemler: Çalışma enine kesitli gözlemsel amaçlı planlandı. Ekokardiyografik olarak MAK tespit edilmiş 50 hasta ile MAK'ı olmayan 50 hasta çalışmaya dahil edildi. Tüm hastalara iki boyutlu transtorasik ekokardiyografi ve KHD analizi için 24 saatlik Holter monitorizasyonu uygulandı. İstatistiksel analiz için Student-t, Mann-Whitney U ve Ki-kare testleri kullanıldı. Bulgular: Hipertansiyon ve koroner arter hastalığı MAK grubunda kontrol grubuna göre daha yüksekti. Ortalama RR süresi, SDNN, SDANN, SDNN indeksi, pNN50 ve RMSSD'yi içeren tüm HRV parametreleri MAK grubunda kontrol grubuna göre azalmış saptandı (p<0,05). Hipertansiyon alt grubunda, ortalama RR süresi dışında diğer tüm HRV parametreleri MAK'lı hastalarda MAK'ı olmayanlara göre azalmış saptandı. Hipertansiyon olmayan hasta alt grubunda ise, tüm HRV parametreleri MAK'lı hastalarda MAK'ı olmayanlara göre yine azalmış saptandı (p<0,05). Koroner arter hastalığı olan hastaların alt grubunda, ortalama RR süresi, pNN50 ve RMSSD dışında tüm HRV parametreleri MAK'lı has...

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Section: Discussionsupporting

confidence: 93%

Impaired heart rate variability in patients with mitral annular calcification: an observational study

Kurtoğlu¹,

Aktürk²,

Korkmaz³

et al. 2013

Anadolu Kardiyol Derg

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“…Similarly, Adler, et al reported that CAD and multivessel disease were more frequent in these patients. 10) In our study, however, we have shown for the first time that the presence or absence of CAS in these patients causes significant differences in the severity and frequency of the CAD. CAD and multivessel disease were significantly more frequent in MAC patients with CAS than in subjects without MAC but with CAS.…”

Section: Discussionmentioning

confidence: 46%

“…[25][26][27] Recent data also suggest that cardiovascular calcification is a strong predictor for the presence of CAD and it was suggested that MAC is a manifestation of diffuse atherosclerosis of the vascular system. 10,17,20,24) The pathophysiology of cardiovascular calcification is not clear, but may be caused by metabolic derangements.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6][7][8] Also, in recent studies, a close relationship has been established between MAC and carotid atherosclerosis (CAS) or coronary artery disease (CAD). [9][10][11] In view of these reports, it has been suggested that MAC is a manifestation of diffuse atherosclerosis of the vascular system. In patients with MAC, cardiovascular risk factors such as hypercholesterolemia, hypertension, and diabetes mellitus are also common, which lends further support to this hypothesis.…”

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confidence: 99%

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Is Carotid Atherosclerosis More Important in Patients With Mitral Annular Calcification Than in Those Without?

et al. 2004

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SUMMARYIt has been suggested that mitral annular calcification (MAC) may be a manifestation of generalized atherosclerosis. However, how the incidence and extent of coronary artery disease (CAD) are affected by the coexistence of carotid atherosclerosis (CAS) in patients with versus without MAC have not yet been studied.We studied 101 patients with echocardiographic MAC and 52 controls without MAC to investigate the clinical impact of CAS on the frequency and severity (defined as the number of obstructed vessels) of CAD in patients with MAC. Carotid Doppler ultrasonographic examination was performed on all patients before coronary angiography. In patients with both MAC and CAS, the incidences of CAD and multivessel disease (≥ 2 vessel or left main coronary artery disease) were significantly higher than in the control group with CAS alone (91% versus 68%, P = 0.008 and 76% versus 44%, P = 0.004, respectively). On the other hand, among study and control patients without CAS, although the frequencies of CAD and multivessel disease were higher in patients with MAC, interestingly, the differences were not statistically significant (37% versus 58% and 15% versus 26%, respectively, P > 0.05 for both). Stepwise multiple logistic regression analysis revealed that CAS (P < 0.001), MAC (P < 0.01) and, to a limited extent hypertension (P = 0.054), were independent predictors for the presence of CAD.In conclusion, the coexistence of CAS is more important in patients with MAC than in those without as it provides valuable information about the incidence and severity of underlying CAD. In cases with MAC but without CAS, MAC could be caused by factors other than atherosclerosis. (Jpn Heart J 2004; 45: 603-611)

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“…Boon et al reported that MAC and aortic valvular calcification should be regarded as signs of extensive atherosclerosis [16]. In addition, MAC is correlated with cardiovascular events including atrial fibrillation, atherosclerotic disease, stroke, and death [17].…”

Section: Annals Of Clinical and Laboratory Research Issn 2386-5180mentioning

confidence: 99%

Evaluation of the Tp-e Interval and Tp-e/QT Ratio in Patients with Mitral Annular Calcification

Afşin¹,

YÃ„Â±lmaz²,

Deger³

et al. 2017

Ann Clin Lab Res

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Objective: Mitral annular calcification (MAC) is regarded as a manifestation of cardiovascular disease. Recent studies have shown that prolongation of the interval between the peak and end of the T wave on electrocardiogram (Tp-e), which is accepted as an index of transmural dispersion of ventricular repolarization, and the Tp-e/QT ratio are associated with ventricular arrhythmias. In the present study, we aimed to evaluate ventricular repolarization using the Tp-e interval and Tpe/QT ratio in patients with MAC.Methods: Fifty patients with MAC (27 females and 23 males; mean age 71.6 ± 8.0 years) and 50 patients without MAC (26 females and 24 males; mean age 69.3 ± 6.2 years) were included in this study. Maximum and minimum QT and Tp-e intervals as well as corrected values according to heart rate were calculated using a 12-lead electrocardiogram. QT dispersion and Tp-e/QT ratios were calculated. All parameters were compared between the two groups. Results:Patients with MAC had significantly higher Tp-e (75.8 ± 11.6 vs. 62.1 ± 8.7; p<0.001) and cTp-e intervals (84.9 ± 14.3 vs. 67.5 ± 9.7; p<0.001), Tp-e/QT (0.19 ± 0.02 vs. 0.15 ± 0.02; p<0.001) and cTp-e/QT ratios (0.19 ± 0.03 vs. 0.15 ± 0.02; p<0.001), and cQT values (390.1 ± 31.5 vs. 373.8 ± 26.1; p=0.006) compared with the control subjects. There were positive correlations between E/Em ratio and cTp-e interval (r=0.396; p=0.004) and between the E/Em ratio and cTp-e/QT ratio (r=0.535; p<0.001) in the MAC group. Conclusion:Our findings indicate that the patients with MAC had higher Tp-e and cTp-e intervals and Tp-e/QT and cTp-e/QT ratios compared with the subjects without MAC.

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Mitral annular calcium detected by transthoracic echocardiography is a marker for high prevalence and severity of coronary artery disease in patients undergoing coronary angiography

Cited by 111 publications

References 27 publications

Impaired heart rate variability in patients with mitral annular calcification: an observational study

Impaired heart rate variability in patients with mitral annular calcification: an observational study

Is Carotid Atherosclerosis More Important in Patients With Mitral Annular Calcification Than in Those Without?

Evaluation of the Tp-e Interval and Tp-e/QT Ratio in Patients with Mitral Annular Calcification

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