Mitral Annular Calcification as a Possible Nidus for Endocarditis: A Descriptive Series with Bacteriological Differences Noted

Pressman, Gregg S.; Rodriguez-Ziccardi, Mary; Gartman, Charles H.; Obasare, Edinrin; Melendres, Emmanuel; Arguello, Vivian; Bhalla, Vikas

doi:10.1016/j.echo.2017.01.016

Cited by 31 publications

(23 citation statements)

References 29 publications

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“…Pressman et al suggested that MAC may act as a possible nidus of infective endocarditis and vegetation frequently occurring on calcific nodules, increasing affinity to specific bacterial species as S. aureus. 17 Stroke from MAC = associated infective vegetation is likely to increase as the population ages and MAC is more prevalent in the elderly population.…”

Section: Discussionmentioning

confidence: 99%

“…The MESA study showed a strong correlation between atrial fibrillation and MAC and increased risk of atrial fibrillation in patients with MAC progression [15,16]. In addition, MAC is suggested as a possible nidus for infective endocarditis and associated vegetation that would increase risk of stroke [17]. Some studies, however, suggest an association between MAC and stroke as resulting from shared risk factors [18,19].…”

Section: Introductionmentioning

confidence: 99%

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Morphological and functional characteristics of mitral annular calcification and their relationship to stroke

et al. 2020

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BackgroundMitral annular calcification (MAC) is associated with risk of stroke. This study aimed to define the morphological and functional characteristics of MAC that are related to stroke. MethodsA total of 460 subjects with MAC from transthoracic echocardiography in a single center from 2012 to 2016 was retrospectively reviewed. Subjects were classified into two groups according to history of stroke [Group 1 (n = 366): without stroke; Group 2 (n = 94): with stroke]. Morphological and functional features of MAC on echocardiogram were scored from 0 to 3 according to MAC mobility, presence of echodense mass with central echolucencies in the periannular region suggesting caseous necrosis, and functional stenosis. ResultsSignificantly more patients in group 2 were men and had history of diabetes mellitus, dyslipidemia, atrial fibrillation, or infective endocarditis. Although MAC thickness and extent did not differ between the two groups, group 2 showed a considerably higher MAC score than group 1 (0.50 ± 0.77 vs. 0.23 ±0.52 p<0.001) as a result of the higher prevalence of each component in group 2 [mobility (22 vs. 11%, p = 0.003), echodense mass with central areas of echolucencies suggesting caseous necrosis (23 vs. 7%, p<0.001), and functional mitral stenosis (12 vs. 7%, p = 0.042)]. On logistic regression analysis, MAC score was independently associated with stroke and showed significant incremental value to demographic factors and comorbidities in association with stroke in a consecutive manner. ConclusionsIn conclusion, morphological and functional characteristics of MAC had incremental value in association with stroke over traditional risk factors. MAC score consisting of MAC mobility, typical echodense mass with central echolucencies suggesting caseous necrosis, and PLOS ONE | https://doi.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Morphological and functional characteristics of mitral annular calcification and their relationship to stroke

et al. 2020

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“…The mechanism through which MAC is infected remains unclear. Pressman et al reported that 16 of 22 patients with vegetation on MAC were infected with S. aureus ( 14 ). They mentioned that S. aureus adhered to the endocardium by a different mechanism from streptococcal species, and that it could have more affinity for osteoblastic changes, which would be caused inside MAC.…”

Section: Discussionmentioning

confidence: 99%

Infective Endocarditis on Caseous Calcification of the Mitral Annulus Involving Both the Anterior and Posterior Annulus: A Rare Case Report

et al. 2018

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A 72-year-old man with end-stage renal disease and who was on dialysis was admitted with fever and chills. Two years previously, he had been diagnosed with caseous calcification of the mitral annulus (CCMA). Blood cultures revealed Staphylococcus aureus, and echocardiography revealed vegetation attached to the CCMA lesion, progressing to both the anterior and posterior annulus. Infective endocarditis (IE) was diagnosed and antibiotic (ampicillin) treatment was initiated. Emergent mitral valve replacement was performed after the occurrence of multiple cerebral infarctions. During surgery, we identified vegetation attached to the CCMA lesion. After surgery, the patient showed a good recovery and was discharged. This case demonstrates that IE can be complicated with CCMA.

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“…Mitral stenosis can also occur as calcium encroaches on the leaflets. Vegetations form at the base of the mitral leaflet [39] rather than the leaflet closure line, as seen with typical regurgitant lesions [17] and are localised accurately with 3-D echo. Although MAC predisposes to IE, the exact risk is unknown.…”

Section: Mitral Valve Sclerosis and Age-related Changesmentioning

confidence: 99%

“…Normal sphincteric action of the annulus is altered and MR ensues [17]. Inflammation accompanies MAC and complications such as ulcerative erosion, thrombus formation, systemic embolic, liquefaction necrosis, infected vegetations and abscess formation occur with increased frequency [34,39]. With large protruding MAC deposits, it is theorised there is alteration of local blood flow, predisposing to NBTE and IE [39].…”

Section: Mitral Valve Sclerosis and Age-related Changesmentioning

confidence: 99%

The Role of Modern-Era Echocardiography in Identification of Cardiac Risk Factors for Infective Endocarditis

Sedgwick¹,

Scalia²

2018

Advanced Concepts in Endocarditis

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This chapter provides an updated overview of the scientific literature on cardiac pathology predisposing to infective endocarditis and the estimated risk associated with selected lesion-specific abnormalities, in an era of changing epidemiology and advanced echocardiographic imaging. Importantly, with the evolution of modern-era echo, subtle changes in valve structure and function are now easily detectable and a proportion of cases of apparently 'normal' valves involved with IE, may in fact have subtle pre-existing pathological and/or haemodynamic abnormalities. The chapter will have a clinical focus with an aim to provide the Physician with up-to-date and practical information on cardiac risk factor identification for infective endocarditis.

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Mitral Annular Calcification as a Possible Nidus for Endocarditis: A Descriptive Series with Bacteriological Differences Noted

Cited by 31 publications

References 29 publications

Morphological and functional characteristics of mitral annular calcification and their relationship to stroke

Morphological and functional characteristics of mitral annular calcification and their relationship to stroke

Infective Endocarditis on Caseous Calcification of the Mitral Annulus Involving Both the Anterior and Posterior Annulus: A Rare Case Report

The Role of Modern-Era Echocardiography in Identification of Cardiac Risk Factors for Infective Endocarditis

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