Mitral Annulus Calcification is associated with valvular and cardiac structural abnormalities

Abstract

IntroductionMitral annulus calcification (MAC) is a common finding on echocardiographic examination. The goal of this study was to evaluate associations between MAC and cardiac abnormalities using a large echocardiographic database.MethodsFor this study we retrospectively reviewed 24,380 echocardiograms performed for clinical reasons between the years 1984 and 1998.ResultsMAC was reported in 1,494 (6.1%) subjects. Using multivariate analysis, age, left ventricular hypertrophy (LVH), mitral regurgitation (MR), tricuspid regurgitation (TR), aortic stenosis (AS), left atrial (LA) enlargement and reversed E/A ratio were independently associated with MAC.)MAC was noted in 11.7 % of patients with MR vs. 4.3% without MR (OR: 2.0, CI 1.6–2.6, p < 0.0001), in 13.9% of those with TR vs. 4.5% without TR (OR: 3.8, CI 2.9–4.8, p < 0.0001), in 10.6% with LVH vs. 4.2% without LVH (OR: 1.9, CI 1.5–2.4, p < 0.0001), in 14.8% with AS vs. 5.5% without AS (OR: 1.4, CI 1.08–1.9, p = 0.01), in 9.4% with reversed E/A ratio vs. 3.8% without reversed E/A ratio (OR: 1.7, CI 1.4–2.2, p < 0.0001) and in 8.2% with LA enlargement vs. 4.8% without LA enlargement (OR: 1.3, CI 1.06–1.7, p = 0.02).ConclusionIn our study, MAC independently correlated with significant structural heart abnormalities. This suggests that identification of MAC may serve as a marker for other cardiac structural disorders.

Caseous mitral annular calcifications: Multimodality imaging characteristics

“…Calcification of the mitral annulus is usually considered an idiopathic, degenerative condition of the mitral annulus, occurring most commonly in older, female patients [7] . This condition is characterized by the development of coarse calcifications along the mitral annulus, and is seldom associated with other signs of mitral valve disease [8] .…”

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

“…The increased sympathetic activity and decreased parasympathetic tone could be detrimental and contribute to the higher cardiovascular mortality rate in patients with MAC (1,24). Possible mechanisms by which MAC may impact HRV may be due to that MAC might cause restriction of mitral annular motion and dilatation necessary for normal valvular motion resulting in abnormal mitral inflow velocities (25), degenerative process within the mitral annulus associated with or accompanied by a "sclerodegenerative process" within the conduction system or within the intrinsic cardiac nerves and cardiac receptors (26,27), and increased left atrial size (28,29).…”

Clinical Importance of Idiopathic Mitral Annular Calcification

“…Недавно были опубликованы данные о более частом выявлении при маг-нитно-резонансной томографии у пожилых больных с КМК перенесенных латентных инсультов [42]. Остается не-ясным, насколько влияние КМК на риск ишемических ин-сультов реализуется непосредственно за счет тромбооб-разования на кальцинатах [43], через предрасполагаю-щие к тромбозу ушка левого предсердия (ЛП) состояния, такие как ФП [5] и увеличение ЛП [4], или происходят эм-болии фрагментами кальцината [44].…”

“…Ассоциация КМК с повышенным риском смерти от сосудистых заболева-ний была подтверждена и при длительном наблюде-нии большой когорты больных разных этнических групп в недавнем исследовании Northern Manhattan Study [2]. Однако клиническое значение КМК остается недостаточно ясным, и обычно КМК расценивается кар-диологами просто как случайная находка инструмен-тального исследования [3].Частота КМК у взрослых колеблется от 6,1 до 15% в популяционных исследованиях [4][5][6], до 35% у больных с тяжелой ишемической болезнью сердца (ИБС) [7]. КМК чаще встречается у пожилых больных, приводятся данные о выявлении КМК почти у трети лю-дей в возрасте старше 75 лет [8-10] и почти у всех дол-гожителей [11].…”