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Mitral Annular Calcification as a Possible Nidus for Endocarditis: A Descriptive Series with Bacteriological
Gregg S Pressman1, Mary Rodriguez-Ziccardi2, Charles H Gartman3
1Division of Cardiology, Heart and Vascular Institute, Einstein Medical Center, Philadelphia, Pennsylvania.
Summary
Mitral annular calcification (MAC) often serves as a site for infective endocarditis, particularly with Staphylococcus aureus. This study highlights MAC
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Imaging
Background:
- Mitral annular calcification (MAC) is a chronic inflammatory process similar to atherosclerosis, prevalent in elderly and renally impaired patients.
- While associated with cardiovascular disease, MAC's link to infective endocarditis (IE) remains unclear.
- This study investigated MAC prevalence in patients with mitral valve vegetations and potential bacteriological differences.
Observation:
- A retrospective review of 56 patients with native mitral valve vegetations was conducted.
- Echocardiograms were analyzed for the presence and location of MAC and vegetations.
- Infective endocarditis diagnosis was confirmed using the modified Duke criteria.
Findings:
- Thirty-four (61%) patients had MAC, with vegetations located on calcific nodules in 22 (65%) of these cases.
- Staphylococcus aureus was more frequently found on MAC (57%) compared to other bacterial species (21%, P = .01).
- Streptococcal infections predominantly involved leaflets (94%) rather than MAC.
Implications:
- Mitral annular calcification may serve as a nidus for infective endocarditis, especially in S. aureus infections.
- Differential attachment mechanisms of S. aureus and streptococci to MAC could explain observed vegetation patterns.
- Understanding these associations can inform IE diagnosis and management strategies.