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Frequency of mitral annular calcification in patients on hemodialysis estimated by 2-dimensional echocardiography
V Raos1, B Jeren-Strujić, M Antos
1Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia.
Insights
Mitral annular calcification (MAC) is common in hemodialysis patients, correlating with longer dialysis duration and elevated calcium and phosphorus levels. This degenerative process may lead to cardiac complications.
Area of Science:
- Cardiology
- Nephrology
- Medical Imaging
Background:
- Mitral annular calcification (MAC) is a degenerative process linked to left ventricular hypertrophy and atherosclerosis, typically seen in older adults.
- Patients with chronic renal insufficiency often exhibit premature atherosclerosis.
- Understanding MAC in hemodialysis patients is crucial due to potential cardiovascular sequelae.
Purpose of the Study:
- To determine the frequency of MAC in patients undergoing hemodialysis.
- To investigate correlations between MAC intensity and hemodialysis duration, age, sex, calcium/phosphorus metabolism, parathormone levels, and atherogenic factors.
Main Methods:
- A cohort of 40 hemodialysis patients (20-67 years old) was studied.
- M-mode and 2-D echocardiography were utilized for MAC assessment and quantification.
- Patients were categorized based on the presence and severity of MAC.
Main Results:
- MAC was present in 57.5% of the hemodialysis patients.
- A positive correlation was found between MAC and serum calcium and phosphorus levels (p < 0.05).
- MAC intensity showed a statistically significant correlation with the duration of hemodialysis (p < 0.05).
- Increased HDL cholesterol levels were also observed.
Conclusions:
- Mitral annular calcification is prevalent in hemodialysis patients.
- MAC in this population is associated with key biochemical markers and treatment duration.
- MAC may contribute to cardiac calcified syndrome, potentially causing conduction disturbances, valvular issues, and embolic events.
Abstract:
Mitral annular calcification (MAC) is a degenerative process associated with left ventricular hypertrophy (HLV) and progressive atherosclerosis, characteristic of the older age groups. Numerous investigations point to significantly earlier onset of atherosclerosis process in patients in final stage of chronic renal insufficiency. The aim of investigation was to determinate the MAC frequency in patients on hemodialysis and to try to find the correlation between MAC intensity and the duration of hemodialysis, age, sex, Ca/P, metabolism, level of parathormone and atherogenic factors. A group of 40 patients on hemodialysis (aged 20 to 67, 26 men and 24 women) were divided int two groups; group 1 without MAC, N = 17 (42.5%), X = 3.5, SD = 3.1; and group 2 with MAC, N = 23 (57.5%), X = 6.2, SD = 2.4. M-mode and 2-D echocardiography were performed in all patients. Group 2 was divided into three subgroups according to MAC quantitation: mild N = 16 (70%), severe, N = 4 (17%), moderate, N = 3 (13%). Study results showed positive correlation between MAC and serum values of Ca and P (p < 0.05). Increased values of HDL cholesterol, statistically significant at the level p < 0.05 were observed. Study results showed the correlation between MAC and time factor, i.e. duration of dialysis treatment to be statistically significant (p < 0.05). Cardiac calcified syndrome could be a sequela of MAC causing conduction disturbances, valvular stenosis or insufficiency, and arterial emboli or endocarditis.