Advanced mitral annular calcification is associated with severe coronary calcification on fast dual spiral computed tomography.

RATIONALE AND OBJECTIVES Mitral annular calcification (MAC) may be a form of atherosclerosis and can lead to serious clinical consequences. The possible linkage between the presence and extent of MAC and coronary calcium score on CT is unknown. The goal of the present study was to investigate whether an association between MAC and coronary calcification (CC) exists in hypertensive patients with increased cardiovascular risk. METHODS Five hundred twenty-two patients (284 men and 238 women, age range 52-80 years, mean 65+/-6 years), who were recruited to the INSIGHT study in the authors' region, underwent fast spiral CT of the heart as well as an echo Doppler examination. MAC was defined as advanced when the thickness of the calcium deposit was 5 mm or more; it was defined as trivial otherwise. RESULTS The advanced MAC group comprised 62 patients, the trivial MAC group 215 patients, and the control group (without MAC) 245 patients. The prevalence of nonsevere CC was similar among the study groups, whereas the prevalence of severe CC (total calcium score >300) and the prevalence of proven coronary artery disease were associated with the presence and extent of MAC: respectively, 12% and 15% in control patients, 18% and 20% in patients with trivial MAC, and 29% and 29% in patients with advanced MAC. Multivariate analysis identified advanced MAC as an independent variable associated with severe CC and proved coronary artery disease. CONCLUSIONS The results of this study demonstrated an association of advanced MAC and severe CC on spiral CT and proved coronary artery disease on the clinical level. Thus, advanced but not trivial MAC makes the noninvasive diagnosis of coronary atherosclerosis more likely and presumably could be considered as a new indication for further coronary evaluation in high-risk patients.

[1]  L E Ginzton,et al.  Coronary calcium does not accurately predict near-term future coronary events in high-risk adults. , 1999, Circulation.

[2]  W. Roberts.  The senile cardiac calcification syndrome. , 1986, The American journal of cardiology.

[3]  Y. Adler,et al.  Mitral annular calcium detected by transthoracic echocardiography is a marker for high prevalence and severity of coronary artery disease in patients undergoing coronary angiography. , 1998, The American journal of cardiology.

[4]  W. Roberts,et al.  Mitral Valvular Disease: A Clinicopathologic Survey of the Conditions Causing the Mitral Valve To Function Abnormally , 1972 .

[5]  M. Budoff,et al.  Prognostic value of coronary calcification and angiographic stenoses in patients undergoing coronary angiography. , 1996, Journal of the American College of Cardiology.

[6]  W. Aronow,et al.  Correlation of serum lipids, calcium and phosphorus, diabetes mellitus, aortic valve stenosis and history of systemic hypertension with presence or absence of mitral anular calcium in persons older than 62 years in a long-term health care facility. , 1987, The American journal of cardiology.

[7]  H. Mabuchi,et al.  Coronary calcification and coronary atherosclerosis: site by site comparative morphologic study of electron beam computed tomography and coronary angiography. , 1997, Journal of the American College of Cardiology.

[8]  Y. Arad,et al.  Predictive value of electron beam computed tomography of the coronary arteries. 19-month follow-up of 1173 asymptomatic subjects. , 1996, Circulation.

[9]  D. Tanné,et al.  Association between mitral annulus calcification and carotid atherosclerotic disease. , 1998, Stroke.

[10]  M. Budoff,et al.  Ultrafast computed tomography as a diagnostic modality in the detection of coronary artery disease: a multicenter study. , 1996, Circulation.

[11]  R. Detrano,et al.  Prognostic significance of coronary calcific deposits in asymptomatic high-risk subjects. , 1997, The American journal of medicine.

[12]  Y Itzchak,et al.  Calcification of coronary arteries: detection and quantification with double-helix CT. , 1995, Radiology.

[13]  A. Tenenbaum.  Coronary calcium and coronary disease: specificity is better than it seems. , 1996, Circulation.

[14]  J. Canty,et al.  Fast computed tomography detection of coronary calcification in the diagnosis of coronary artery disease. Comparison with angiography in patients < 50 years old. , 1994, Circulation.

[15]  C. Zoccali,et al.  Does high salt intake cause hyperfiltration in patients with essential hypertension? , 1996, Journal of human hypertension.

[16]  Y. Itzchak,et al.  Double-helical CT as a new tool for tracking of allograft atherosclerosis in heart transplant recipients. , 1999, Investigative radiology.

[17]  J F Breen,et al.  Coronary calcium, as determined by electron beam computed tomography, and coronary disease on arteriogram. Effect of patient's sex on diagnosis. , 1995, Circulation.

[18]  J. Lodder,et al.  Cardiac valve calcification: characteristics of patients with calcification of the mitral annulus or aortic valve , 1997, Heart.

[19]  R. Detrano,et al.  Electron beam computed tomographic coronary calcium as a predictor of coronary events: comparison of two protocols. , 1997, Circulation.

[20]  G. Mancia,et al.  The International Nifedipine GITS Study of Intervention as a Goal in Hypertension Treatment (INSIGHT) trial. , 1998, The American journal of cardiology.

[21]  H. Hodkinson,et al.  Valvular calcification in the elderly: possible pathogenic factors. , 1978, Journal of gerontology.

[22]  V. Fuster,et al.  Coronary artery calcification: pathophysiology, epidemiology, imaging methods, and clinical implications. A statement for health professionals from the American Heart Association. Writing Group. , 1996, Circulation.

[23]  C. Nair,et al.  Long-term follow-up of patients with echocardiographically detected mitral anular calcium and comparison with age- and sex-matched control subjects. , 1989, The American journal of cardiology.

[24]  S. Gentile,et al.  Slowing of mitral valve annular calcium in systemic hypertension by nifedipine and comparisons with enalapril and atenolol. , 1993, The American journal of cardiology.

[25]  A. Tenenbaum,et al.  Comparison of coronary calcium in stable angina pectoris and in first acute myocardial infarction utilizing double helical computerized tomography. , 1998, The American journal of cardiology.

[26]  W. Aronow,et al.  Sensitivity, specificity, positive predictive value, and negative predictive value of mitral anular calcium detected by chest roentgenograms correlated with mitral anular calcium diagnosed by echocardiography in elderly patients , 1987 .

[27]  R. Detrano,et al.  Prognostic significance of cardiac cinefluoroscopy for coronary calcific deposits in asymptomatic high risk subjects. , 1994, Journal of the American College of Cardiology.

[28]  Y. Itzchak,et al.  Absence of coronary calcification on double-helical CT scans: predictor of angiographically normal coronary arteries in elderly women? , 1996, Radiology.

[29]  W. Kannel,et al.  Prevalence of submitral (anular) calcium and its correlates in a general population-based sample (the Framingham Study). , 1983, The American journal of cardiology.

[30]  Aronow Ws.  Mitral annular calcification: significant and worth acting upon. , 1991, Geriatrics.

[31]  J F Breen,et al.  Coronary artery calcification detected with ultrafast CT as an indication of coronary artery disease. , 1992, Radiology.

[32]  R. Detrano,et al.  Coronary calcium and atherosclerosis by ultrafast computed tomography in asymptomatic men and women: relation to age and risk factors. , 1994, American heart journal.