Mitral Stenosis: Making the diagnosis

The case of a 60-year-old man illustrates a number of important features of rheumatic heart disease (RHD). The patient’s age of presentation was late (>50 yo) and he had no history of predisposing condition for RHD but served in the South Pacific when he was in the US Navy. RHD was limited to mitral stenosis in this patient and his presentation of heart failure was late. His ECG revealed ample evidence of right ventricular enlargement, and echocardiography demonstrated severe mitral stenosis, enlarged right ventricle and right atrium and marked pulmonary hypertension. Because percutaneous balloon mitral valve commissurotomy was precluded by the degree of mitral valve calcification, he underwent successful surgical valve replacement with relief of symptoms. Although RHD is rarely encountered in North America and Europe, it remains a major cause of mortality in the developing nations.

Prevalence and clinical implications of valvular calcification on coronary computed tomography angiography

Aims Valvular heart disease can be identified by calcification on coronary computed tomography angiography (CCTA) and has been associated with adverse clinical outcomes. We assessed aortic and mitral valve calcification in patients presenting with stable chest pain and their association with cardiovascular risk factors, coronary artery disease, and cardiovascular outcomes. Methods and results In 1769 patients (58 ± 9 years, 56% male) undergoing CCTA for stable chest pain, aortic and mitral valve calcification were quantified using Agatston score. Aortic valve calcification was present in 241 (14%) and mitral calcification in 64 (4%). Independent predictors of aortic valve calcification were age, male sex, hypertension, diabetes mellitus, and cerebrovascular disease, whereas the only predictor of mitral valve calcification was age. Patients with aortic and mitral valve calcification had higher coronary artery calcium scores and more obstructive coronary artery disease. The composite endpoint of cardiovascular mortality, non-fatal myocardial infarction, or non-fatal stroke was higher in those with aortic [hazard ratio (HR) 2.87; 95% confidence interval (CI) 1.60–5.17; P < 0.001] or mitral (HR 3.50; 95% CI 1.47–8.07; P = 0.004) valve calcification, but this was not independent of coronary artery calcification or obstructive coronary artery disease. Conclusion Aortic and mitral valve calcification occurs in one in six patients with stable chest pain undergoing CCTA and is associated with concomitant coronary atherosclerosis. Whilst valvular calcification is associated with a higher risk of cardiovascular events, this was not independent of the burden of coronary artery disease.

Abstract 15249: Association of Coronary Artery and Extra-coronary Calcification With Reduced Physical Function and Frailty in Older Adults: The Atherosclerosis Risk in Communities Study

Introduction: Coronary artery calcium (CAC) and extra-coronary calcification (ECC) have been associated with age-related phenotypes such as cognitive impairment. However, their relationship with poor physical function and frailty/pre-frailty in older adults is unclear. Hypothesis: CAC and ECC (aortic valve, aortic valve ring, mitral valve, ascending aorta, and descending aorta) are associated with poor physical function and frailty/pre-frailty. Methods: We defined poor physical function as a Short Physical Performance Battery (SPPB) score ≤9 and frailty/pre-frailty as the presence of at least one frailty criterion: weight loss, slow walking speed, exhaustion, low grip strength, and low physical activity. The number of vascular beds with any calcification (CAC and five ECC sites [0-6]) was calculated for a composite measure of calcification. Logistic regression was used to quantify cross-sectional associations with SPPB or frailty/pre-frailty among 1,564 ARIC participants aged 74-92 without prior CVD at visit 7 (2018-19). Results: The prevalence of low SPPB, frailty, and pre-frailty was 50%, 5%, and 56%, respectively. Highest (vs. lowest) quartile of aortic valve and mitral valve calcification was associated with low SPPB (OR 1.47 [1.15, 1.88] and 1.53 [1.19,1.97]) and frailty/pre-frailty (1.34 [1.05, 1.71] and 1.41 [1.10, 1.80]). Aortic valve ring calcification was associated with frailty/pre-frailty, and descending aorta calcification with low SPPB. The total number of calcified vascular beds demonstrated a dose-response relationship to both outcomes (Table), with 5-6 calcified vascular beds demonstrating ~2-fold higher odds. Conclusions: Cardiovascular calcification, especially aortic valve and mitral valve calcification, was robustly associated with higher risk of poor physical function and frailty/pre-frailty, suggesting the potential etiological link between cardiovascular calcification and functional decline at older age.

Evaluation of serum sclerostin level and its correlation with valvular calcification in haemodialysis patients

Background The majority of hemodialysis patients are affected by the cardiovascular calcification. Vascular/valvular calcification contributes to an extremely high cardiovascular morbidity and mortality in HD patients. Objective To asses circulating levels of Scl in ESRD patients receiving HD and their relation to aortic and mitral valve calcification detected by echocardiography as well. Patients and Methods The study included 80 ESRD patients undergoing HD in Al-Sahel Nephrology and Dialysis unit. Routine chemical investigations, serum sclerostin by ELISA were done to all patients, as well a trans-thoracic Echocardiography. Results serum Scl level ranged from 0.41 ng\ml to 1.65 ng\ml. calcification was documented in 53/80 (66.2%) of our HD patients: 26/80 had aortic valve calcification only(32.5%), 6/80 patients (7.5%) had mitral valve calcification alone, while 21/80 of patients had both aortic and mitral valves calcification (26.25%). 27/80 (33.75%) patients had no calcification. We didn’t find any significant correlation between serum Scl level and valvular calcification nor age, sex or HD duration. Conclusion valvular calcification are prevalent in HD population. Serum Scl was not associated with valvular calcification.