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Mitral annular calcification as a predictor of stroke in the multiethnic study of atherosclerosis

Afiachukwu Onuegbu1, Francesca Calicchio1, April Kinninger1

  • 1Division of Cardiology, Lundquist Institute at Harbor UCLA Medical Center, Torrance, California, USA.

Journal of Cardiovascular Medicine (Hagerstown, Md.)
|July 6, 2023
PubMed

Insights

Mitral annular calcification (MAC) independently predicts long-term stroke risk. This cardiac CT finding increases stroke risk, even beyond traditional factors like atrial fibrillation, in diverse populations.

Area of Science:

  • Cardiology
  • Radiology
  • Epidemiology

Background:

  • Mitral annular calcification (MAC) is a known risk factor for cardiovascular events.
  • Recent data is needed on the association between cardiac CT-derived MAC and long-term stroke risk.

Purpose of the Study:

  • To investigate the association between cardiac computed tomography (CT) derived mitral annular calcification (MAC) and 15-year stroke risk.
  • To assess if MAC is an independent predictor of stroke in a racially diverse cohort.

Main Methods:

  • Analysis of 6814 participants from the Multiethnic Study of Atherosclerosis who underwent baseline cardiac CT.
  • MAC scoring using Agatston and volume methods from cardiac CT.
  • Multivariable Cox proportional hazard regression models adjusted for cardiovascular risk factors, inflammatory markers, coronary artery calcium, atrial fibrillation, and left atrial size.

Main Results:

  • 9% of participants had MAC at baseline; 304 strokes occurred over 15 years.
  • Baseline MAC was associated with increased risk for all strokes (HR 1.68) after adjustment.
  • MAC remained an independent predictor of all strokes (HR 1.93) and ischemic stroke (HR 2.03) after further adjustment for atrial fibrillation and left atrial size.

Conclusions:

  • Mitral annular calcification (MAC) is an independent predictor of long-term stroke risk.
  • This association holds true in a racially diverse population.
  • MAC provides prognostic information beyond conventional cardiovascular risk factors and atrial fibrillation.
Abstract

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