RELATIONSHIPS OF MITRAL ANNULAR CALCIFICATION TO CARDIOVASCULAR RISK FACTORS: THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS (MESA)

BACKGROUND: Mitral annular calcification (MAC) is common in the elderly, and is associated with atherosclerotic risk factors. We sought to determine the magnitude of association between MAC and vascular events in the multiethnic prospective cohort of northern Manhattan. METHODS: MAC was assessed by transthoracic 2D-echocardiography as binary (yes/no) and continuous (mm) variable. Subjects were aged ≥40 years at enrollment, and were free of prior myocardial infarction (MI) and stroke. The association between MAC and MI, ischemic stroke, and vascular death was examined, adjusting for established cardiovascular risk factors and for carotid artery stenosis (>60%) by means of Cox regression analysis. RESULTS: Of 1,958 subjects, 502 (25.7%) had MAC. MAC was significantly associated with age, systolic blood pressure, male gender and history of atrial fibrillation. During a mean follow-up of 7.4 ± 2.5 months, there were 100 MI, 104 ischemic stroke and 156 vascular deaths recorded. After adjustment for other risk factors, MAC was associated with an increased risk of MI (HR 1.72, 95%CI 1.13–2.63; p=0.012) and vascular death (HR 1.57, 95%CI 1.12–2.20; p=0.008), but not of ischemic stroke (HR 1.36, 95%CI 0.89 –2.06; p=0.16). When MAC was categorized into mild to moderate (1– 4mm, n=253; 13.1%) or severe (≥4mm, n=245; 12.7%), severe MAC remained as a strong and independent predictor of vascular events, but not stroke (Table ). CONCLUSION: MAC was a strong and independent predictor for MI and vascular death in this multiethnic cohort especially when its thickness is more than 4mm. Its predictive value for ischemic stroke was not independent of other cardiovascular risk factors. Table. Association of MAC severity with clinical vascular outcomes.

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Epicardial adipose tissue and its association with cardiovascular risk factors and mitral annular calcium deposits

Ultrasound ◽

10.1177/1742271x19846159 ◽

2019 ◽

Vol 27 (4) ◽

pp. 217-224

Author(s):

Maryam Nabati ◽

Alireza Salehi ◽

Ghazal Hatami ◽

Mozhdeh Dabirian ◽

Jamshid Yazdani ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Epicardial Fat ◽

P Value ◽

Mitral Annular Calcification ◽

Epicardial Fat Thickness ◽

Calcium Deposits ◽

Fat Thickness ◽

Annular Calcification

Introduction Epicardial fat is a variety of visceral adipose tissue that secretes pro-inflammatory cytokines that can lead to progression of atherosclerosis. Previous studies have shown a correlation between cardiovascular risk factors and severity of mitral annular calcification. The aim of our study was to assess the correlation between epicardial fat thickness and mitral annular calcification. Methods This study recruited 188 patients who were considered for coronary angiography and underwent echocardiography within 24 hours of admission. Epicardial fat thickness was measured in the parasternal long axis view at the end-systole. Mitral annular calcification was visualized in the parasternal short-axis view and was grade as none, mild, moderate, and severe. Furthermore, left atrial diameter, severity of mitral regurgitation, left ventricular ejection fraction, and early diastolic velocities ( E wave) determined by transmitral pulsed Doppler, the early mitral annular velocities measured by tissue Doppler ( e′), and E/ e′ were obtained. Results Patients with an epicardial fat thickness ≥7 mm had higher prevalence of hypertension and higher SYNTAX score ( p value = 0.002 and 0.0014, respectively). Also, mitral annular calcification was both more prevalent and more extensive ( p value = 0.007 and <0.001, respectively) and left atrial diameter was larger in these patients compared with patients with epicardial fat thickness <7 mm ( p value = 0.001). Conclusions Our study showed significant association between increased epicardial fat thickness and calcium deposits in the mitral valve annulus that is a degenerative process associated with cardiovascular risk factors.

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