Mitral annular calcifications and aortic plaques as predictors of increased cardiovascular mortality

Mitral annular calcifications (MAC) and aortic plaques are predictive for higher incidence of recurrent embolic events, the presence and severity of coronary artery disease and total cardiac deaths. However, no data exist comparing the impact of combined presence of both aortic plaques and MAC on embolic events, deaths associated with cerebral embolism or cardiac deaths during the follow-up.

In 100 consecutive patients with aortic plaques detected by transesophageal echocardiography (mean age 69.8 + 8.9 years, range 39-93 years, 49 males, 51 females) and in 49 age- and sex-matched control subjects (mean age 69.4 + 7.8 years, range 46-89 years, 27 males, 22 females) without aortic plaques (control group), the incidence of embolic events, deaths associated with embolic events and total cardiac deaths were evaluated during a mean follow-up of 32 +/- 9.7 months. The effect of the presence or absence of MAC on these parameters was also evaluated.

Compared with the control group, patients with aortic plaques had a higher frequency of hypertension (p < 0.001), hypercholesterolemia (p < 0.01), smoking history (p < 0.01), MAC (p < 0.00001) and the presence of atherosclerotic changes in the carotid arteries (p < 0.05). During the follow-up, patients with aortic plaques had a higher incidence of stroke or transient ischemic attack (p < 0.0001), deaths associated with stroke (p < 0.005) and total cardiac deaths (p < 0.05) compared with the control group. Patients with both aortic plaques and presence of MAC had during the follow-up a significantly higher incidence of deaths associated with stroke (p < 0.0001, 16.0 times higher) and total cardiac deaths (p < 0.005, 4.7 times higher) compared with those without MAC and the presence of aortic plaques. Multivariant regression analysis showed MAC (p < 0.01) and hypercholesterolemia (p < 0.05) were the only independent predictors of stroke. MAC (p < 0.05) and age (p < 0.000001) were the only independent predictors of total cardiac death and stroke. Independent predictors of both aortic plaques and MAC were coronary artery disease (p < 0.00001), stroke (p < 0.005), hypertension (p < 0.001), female gender (p < 0.01) and hypercholesterolemia (p < 0.005).

The findings of both aortic plaque and mitral annular calcification are highly predictive not only for strokes, but also for deaths associated with cerebral embolism and total cardiac deaths and are probably strong markers for higher severity of coronary artery disease. They are more predictive if both are present simultaneously compared to the presence of either MAC or aortic plaque alone.