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Association between mitral annulus calcification and aortic atheroma: a prospective transesophageal echocardiographic
1Cardiology Department, The Scheingarten Echocardiography Unit, Rabin Medical Center, Beilinson Campus, Petah Tiqva and Sackler Faculty of Medicine, Tel Aviv University, Petah Tiqva 49 100, Tel Aviv, Israel.
Insights
Mitral annulus calcification (MAC) is strongly associated with aortic atheroma (AA), a key factor in stroke risk. This study suggests MAC may serve as a significant marker for aortic atherosclerosis.
Area of Science:
- Cardiology
- Vascular Medicine
- Echocardiography
Background:
- Mitral annulus calcification (MAC) is a known stroke predictor, but its causative link remains unproven.
- Aortic atheroma (AA), particularly complex lesions, is also associated with stroke.
- The relationship between MAC and AA has not been previously established.
Purpose of the Study:
- To investigate the association between mitral annulus calcification (MAC) and aortic atheroma (AA).
- To determine if MAC is a predictor of the presence and severity of AA.
Main Methods:
- Prospective evaluation of 279 patients undergoing transesophageal echocardiography (TEE).
- Comparison of 105 patients with MAC (diagnosed by TTE) versus 174 age-matched patients without MAC.
- Measurement of MAC and AA characteristics, including thickness, protrusion, and mobility, using TTE and TEE.
Main Results:
- Patients with MAC showed significantly higher prevalence and severity of AA compared to those without MAC (91% vs. 44%, P<0.001).
- Complex AA features, such as increased thickness, protrusion, and ulceration, were more common in the MAC group.
- Multivariate analysis identified MAC, hypertension, and age as independent predictors of AA.
Conclusions:
- A significant association exists between the presence and severity of MAC and AA.
- MAC may serve as an important indicator of aortic atherosclerosis.
- This association could partially explain the elevated risk of stroke in patients with MAC.
Background And Purpose:
Although mitral annulus calcification (MAC) has been reported to be a significant independent predictor of stroke, no causative relationship was proven. It is also known that aortic atheroma (AA), especially those >/=5 mm thick and/or protruding and/or mobile are associated with stroke. This study was designed to determine whether an association exists between MAC and AA.
Methods:
We prospectively evaluated the records of 279 consecutive patients who underwent transesophageal echocardiography (TEE) for various indications to measure the presence and characteristics of AA. The 105 patients in whom a diagnosis of MAC was made on transthoracic echocardiography (TTE) immediately preceding the TEE, were compared with 174 age-matched patients without MAC. MAC was defined as a dense, localized, highly reflective area at the base of the posterior mitral leaflet. We measured MAC thickness with two-dimensional-TTE in four-chamber view and AA thickness, protrusion and mobility with TEE. AA was defined as localized intimal thickening of >/=3 mm. A lesion was considered complex if there was plaque extending >/=5 mm into the aortic lumen and/or if it was protruding, mobile or ulcerated.
Results:
No differences were found between the groups in risk factors for atherosclerosis or in indications for referral for TEE. Significantly higher rates were found in the MAC group for prevalence of AA (91 vs. 44%, P<0.001), atheromas >/=5 mm thick (68 vs. 19%, P<0.001), protruding atheromas (44 vs. 15%, P<0.001), ulcerated atheromas (10 vs. 1%, P<0.001) and complex atheroma (74 vs. 22%, P<0.001). Sixty patients had MAC thickness >/=6 mm and 45<6 mm. AA thickness was significantly greater in the patients with a MAC thickness of >/=6 mm (6.1+/-2.8 vs. 5.0+/-2.6 mm, P=0.03). On multivariate analysis MAC, hypertension and age were the only independent predictors of AA (P=0.0001, 0.005 and 0.007, respectively).
Conclusions:
There is a significant association between the presence and severity of MAC and AA. MAC may be an important marker for atherosclerosis of the aorta. This association may explain in part the high prevalence of systemic emboli and stroke in patients with MAC.