Mitral annulus calcification — a window to diffuse atherosclerosis of the vascular system

Adler, Yehuda; Fink, Noam; Spector, David L.; Wiser, Itay; Sagie, Alex

doi:10.1016/s0021-9150(00)00737-1

Cited by 129 publications

(84 citation statements)

References 63 publications

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“…However, when severe, it can contribute to mitral regurgitation and/or stenosis. 18) In our study, none of the patients had mitral regurgitation or stenosis severe enough to affect cardiac function or warrant exclusion from the study.…”

Section: Discussionmentioning

confidence: 71%

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<b>Endothelin-1 and Nitric Oxide Levels in Patients With Mitral Annulus Calcification</b>

et al. 2004

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SUMMARYMitral annulus calcification (MAC) is a chronic degenerative noninflammatory process. The goal of this study was to determine endothelin-1 (ET-1) and nitric oxide (NOx) levels in patients with MAC and compare them with those in normal subjects. The study group included 39 patients [26 females (66%), age, 63 ± 8 years] with MAC and 20 [11 females (55%), age, 61 ± 7 years] healthy subjects. The patients were divided into two subgroups, group A with severe MAC and group B with mild MAC, according to the severity of the MAC. Plasma ET-1 levels were higher and NOx levels were lower in patients than controls [(6.5 ± 5.6 pg/mL vs 3.7 ± 2.9 pg/mL for ET-1 and 35.0 ± 10.6 µmol/L vs 42.3 ± 9.9 µmol/L for NOx; P < 0.05 for both)]. In the subgroups, ET-1 levels were higher in group A than group B (8.65 ± 6.84 pg/mL vs 4.74 ± 3.45 pg/mL, P < 0.05) and the control group (8.65 ± 6.84 pg/mL vs 3.70 ± 2.88 pg/mL, P < 0.05). There was no difference between group B and the control group. Plasma NOx levels were significantly decreased in group A compared to controls (32.22 ± 11.88 µmol/L vs 42.25 ± 9.99 µmol/L, P < 0.05). However, no significant difference was observed between group B (37.38 ± 9.06 µmol/L) and the other groups. Diabetes mellitus, coronary artery disease, and dyslipidemia were significantly associated with ET-1 levels. However, this association was not observed for NOx. In conclusion, patients with MAC have increased ET-1 and decreased NOx levels. This seems to be more prominent in patients with severe MAC. (Jpn Heart J 2004; 45: 487-495)

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Section: Discussionmentioning

confidence: 71%

“…18) In most patients it is asymptomatic and does not affect mitral valve function. However, when severe, it can contribute to mitral regurgitation and/or stenosis.…”

Section: Discussionmentioning

confidence: 99%

<b>Endothelin-1 and Nitric Oxide Levels in Patients With Mitral Annulus Calcification</b>

et al. 2004

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“…Therefore, it is most commonly encountered as an incidental finding during evaluation of pulmonary diseases or other cardiovascular diseases (CVD). 18 Nevertheless, MAC has several prognostic clinical implications and it has been associated with increased risk of atherosclerosis, 19 coronary artery disease, 20 ischemic stroke, 21 atrial fibrillation (AF), 22 conduction system disorders 23 and mortality from CVD. 24 The prevalence of MAC varies depending on the characteristics of the population studied and the diagnostic imaging modality utilized.…”

Section: Mitral Annular Calcificationmentioning

confidence: 99%

“…These include abnormalities in calcium and phosphorus metabolism, increased hemodynamic stress on the MV and atherosclerosis. [17][18][19] Increased prevalence of MAC in patients with MV prolapse have been attributed to the annular trauma secondary to the excess tension caused by redundant hypermobile MV leaflets. 33 A genetic contribution to the risk of MAC has also been described.…”

Section: Mitral Annular Calcificationmentioning

confidence: 99%

Echocardiographic Assessment of Degenerative Mitral Stenosis: A Diagnostic Challenge of an Emerging Cardiac Disease

Oktay¹,

Gilliland²,

Lavie³

et al. 2017

Current Problems in Cardiology

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“…Potential complications include functional mitral stenosis, mitral regurgitation, infective endocarditis, and, rarely, valvular thrombosis. 2 Liquefaction necrosis, also known as caseous MAC, is a less frequent variant of MAC in which the core of the mass comprises amorphous eosinophilic fluid, and the surrounding rim contains multiple areas of calcification and inflammatory cell infiltration. 3 Because of the saddle shape of the mitral annulus, comprehensive evaluation by echocardiography aloneparticularly the exclusion of alternative causes such as tumor, thrombosed coronary sinus, and mitral annular abscess-can be challenging.…”

Section: Commentmentioning

confidence: 99%

Severe Mitral Annular Calcification: Insights from Multimodality Imaging

Shah

Babu‐Narayan

Li³

et al. 2014

Texas Heart Institute Journal

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During transthoracic echocardiography (TTE), a 77-year-old woman with exertional dyspnea was found to have large, well-defined masses adjacent to the mitral valve (Fig. 1). Spectral Doppler echocardiography revealed a mean transmitral gradient of 7 mmHg, a mitral velocity-time integral of 45 cm, and a pressure half-time of 130 ms. There was moderate mitral regurgitation, although the exact mechanism was unclear on TTE. Transesophageal echocardiography revealed that the posterior mass prevented complete leaflet apposition, resulting in regurgitation ( Fig. 2A), whereas the anterior mass was not affecting leaflet motion-so no mitral regurgitation was seen there (Fig. 2B). The echocardiographic appearances seemed to be consistent with mitral annular calcification (MAC), but alternative causes (specifically tumor) were not excluded.During cardiac magnetic resonance (CMR), cine imaging with balanced steadystate free-precession sequences showed immobile, low-signal masses in the mitral annulus. After intravenous gadolinium contrast administration, first-pass perfusion images revealed no enhancement of the mass, in keeping with an avascular structure. On the early gadolinium-enhancement images, the mass remained hypointense, but the corresponding late gadolinium-enhancement images revealed a rim of circum- Images in Cardiovascular Medicine

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Mitral annulus calcification — a window to diffuse atherosclerosis of the vascular system

Cited by 129 publications

References 63 publications

<b>Endothelin-1 and Nitric Oxide Levels in Patients With Mitral Annulus Calcification</b>

<b>Endothelin-1 and Nitric Oxide Levels in Patients With Mitral Annulus Calcification</b>

Echocardiographic Assessment of Degenerative Mitral Stenosis: A Diagnostic Challenge of an Emerging Cardiac Disease

Severe Mitral Annular Calcification: Insights from Multimodality Imaging

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