Relationship between incidentally detected calcification of the mitral valve on 64-row multidetector computed tomography and mitral valve disease on echocardiography

Abstract

BackgroundMitral valve calcification is often incidentally detected on chest computed tomography (CT) scans obtained for a variety of noncardiac indications. In this study, we evaluated the association between mitral valve calcification incidentally detected on chest CT and the presence and severity of mitral valve disease on echocardiography.MethodsOf 760 patients undergoing 64-row multidetector CT of the chest, 50 with mitral valve calcification and 100 controls were referred on for echocardiography. Calcifications of the mitral valve leaflet and annulus were assessed for length, Agatston score, and site, and were compared with echocardiographic findings.ResultsMitral valve calcification was noted in 59 (7.7%) patients on multidetector CT. Fifty of these patients were assessed by echocardiography, and 32 (64%) were found to have mitral annular calcification. Nine patients (18%) had posterior mitral valve leaflet calcification, and both mitral valve leaflet and annular calcification were detected in nine (18%) cases. Nine (18%) patients had mild, three (6%) had moderate, and one (2%) had severe mitral stenosis. None of the patients with isolated mitral annular calcification had mitral stenosis; however, all the patients with mitral stenosis showed mitral valve leaflet calcification with or without mitral annular calcification (P < 0.001). Moreover, patients with mitral stenosis had a larger mitral calcification length and greater Agatston scores in comparison with those without mitral stenosis (P = 0.001). While 31 patients (62%) with mitral calcification had mitral regurgitation on echocardiography, 21 (21%) in the control group showed mitral regurgitation (P = 0.001).ConclusionMitral valve leaflet calcification, with or without annular calcification, may be an indicator of mitral stenosis. Mitral calcification can also be considered as an indicator for mitral regurgitation in general. Therefore, patients with mitral valve calcification detected incidentally on chest CT scan may benefit from functional assessment of the valve using echocardiography.

Degenerative Mitral Stenosis

“…Among patients noted to have mitral valve calcification on multidetector computed tomography, echocardiographic assessment revealed DMS in 26% of cases. 11 Additionally, 62% of all cases had some degree of MR.…”

Current methods to assess mitral annular calcification and its risk factors

“…Aronow et al[72] have found that 10% of 293 patients with MAC on echocardiogram have MS murmur. On the other hand, few studies did not show any significant correlation between the presence of MAC and MS[8,36]. All the MS patients were found to have mitral valve leaflet calcification with or without mitral annular calcification.…”

“…MAC involves the deposition of calcium and lipids in the mitral valve fibrous tissue supporting structure which includes mitral annulus, chordae tendineae, papillary muscles and left ventricular free wall [6]. Previous studies have shown that MAC independently correlates with aortic and mitral valve dysfunction, heart failure, stroke, carotid stenosis, coronary artery disease (CAD), atrial fibrillation (AF), cardiovascular mortality, and overall mortality [7,8].…”

“…Individuals with MAC are at high risk of cardiovascular events, thromboembolic events, pacemaker implantation and valve replacement [8].…”