Mitral annulus calcification  is not an independent risk factor  for stroke: a cohort study of 657 patients

Boon, Arthur; Lodder, J.; Cheriex, Emile C.; Kessels, Fons

doi:10.1007/s004150050140

Cited by 49 publications

(31 citation statements)

References 40 publications

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“…In one study, the presence of MAC was associated with a two-fold increase in the risk of stroke, even in the absence of other risk factors [14] . This risk and other risks associated with MAC remain somewhat controversial, however [15] . MAC should be differentiated from calcifications within the mitral valve itself, which are usually related to significant mitral valve pathology and dysfunction, and are commonly seen in rheumatic heart disease.…”

Section: Discussionmentioning

confidence: 99%

Caseous mitral annular calcifications: Multimodality imaging characteristics

Shriki

Rongey²,

Ghosh³

et al. 2010

WJR

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Author contributions: Shriki J served as the primary author and wrote and finalized the manuscript; Rongey C and Ghosh B researched and wrote the clinical histories of the patients presented; Daneshvar S obtained echocardiographic images and contributed to the sections of the manuscript discussing the echocardiographic appearance of caseous mitral annular calcifications; Colletti PM contributed to the discussion regarding the cardiac MR findings in the patients who were discussed; Farvid A assisted in the discussion of the clinical significance of mitral annular calcifications, and obtained IRB approval for this review; Wilcox A assisted in editing and finalizing the manuscript. AbstractThe authors report herein a series of 3 patients with caseous mitral annular calcifications (MAC). One of the patients presented with mass-like, caseous MAC as an incidental finding on a staging computed tomography (CT) for metastatic colorectal carcinoma. Another patient presented with a nodule on a chest radiograph, which was later found on CT to be due to caseous MAC. In the third patient, caseous MAC was initially detected on echocardiography, and was further evaluated with CT and cardiac magnetic resonance imaging. In all three patients, the appearances posed a diagnostic dilemma. The appearance of caseous MAC is dissimilar to non-caseous MAC and is usually seen as an ovoid, mass-like structure, with homogeneous hyperattenuation, representing a liquefied form of calcium and proteinaceous fluid. This homogeneous center is surrounded by peripheral, shell-like calcifications. Caseous MAC is likely an under-recognized entity and may present a diagnostic dilemma at CT, magnetic resonance imaging, or echocardiography.

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Section: Discussionmentioning

confidence: 99%

Caseous mitral annular calcifications: Multimodality imaging characteristics

Shriki

Rongey²,

Ghosh³

et al. 2010

WJR

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“…Other previous studies have indicated that patients with MAC have a higher incidence of cerebrovascular events. 5,11,12) The Framingham study 11) found an almost two-fold risk of stroke among 1,159 patients with MAC detected by echocardiography; however, concomitant carotid disease was not considered in this study. Nair and associates 5) found that patients with MAC had a 5.0 fold higher risk of developing stroke compared to those without MAC.…”

Section: Discussionmentioning

confidence: 74%

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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“…However, it should be recognized that the contribution of these minor cardiac abnormalities to ischemic stroke is still uncertain [12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31]. …”

Section: Discussionmentioning

confidence: 99%

Lacunar Stroke: Transoesophageal Echocardiographic Factors Influencing Long-Term Prognosis

Kazui¹,

Levi²,

Jones³

et al. 2001

Cerebrovasc Dis

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Objective: Since little is known concerning factors which may influence long-term prognosis of patients presenting with lacunar stroke, we conducted a longitudinal study of this stroke subtype. Variables likely to affect outcome were assessed at baseline, including those from transoesophageal echocardiographic studies. Methods: Consecutive patients presenting with first-ever lacunar stroke underwent diagnostic workup that included brain CT or MRI, carotid duplex, and transthoracic and transoesophageal echocardiography. An assessment of patients was planned at entry (baseline), and thereafter every 12 months (clinic visit or telephone call), drop-out, or endpoint. The primary endpoint was nonfatal or fatal stroke. Secondary endpoint was death due to any cause. Results: Among 60 consecutive lacunar patients with the mean follow-up period of 3.9 years, 12 patients (20%) had stroke recurrence. The mean annual rate for stroke was 5.2%, and for death 2.8%. For multivariate Cox proportional hazards analysis, the following three variables with the values of p < 0.1 after univariate testing were chosen: age (p = 0.095); aortic atheroma (p = 0.066); and any source of embolism from heart (p = 0.007). Any source of embolism from heart was the only factor which significantly enhanced the risk of stroke recurrence (p = 0.015). Using Kaplan-Meier life table analysis, the curves of percent free of recurrent stroke were significantly different (log rank test p = 0.002). Conclusions: Until the mechanism of lacunar stroke is better understood, it is reasonable to suggest that its investigation and prevention should be directed at all potential causes of future strokes including cardioembolism.

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Mitral annulus calcification is not an independent risk factor for stroke: a cohort study of 657 patients

Cited by 49 publications

References 40 publications

Caseous mitral annular calcifications: Multimodality imaging characteristics

Caseous mitral annular calcifications: Multimodality imaging characteristics

Association Between Mitral Annular Calcification and Stroke

Lacunar Stroke: Transoesophageal Echocardiographic Factors Influencing Long-Term Prognosis

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