Coronary artery disease
Relation of Mitral Annular Calcium and Coronary Calcium (from the Multi-Ethnic Study of Atherosclerosis [MESA])

https://doi.org/10.1016/j.amjcard.2011.01.005Get rights and content

Atherosclerosis is a complex diffuse disorder. The close correlation between coronary artery calcium (CAC) score on computed tomogram and extent and severity of coronary atherosclerosis is well established. It has been suggested that mitral annular calcification (MAC) may be a manifestation of generalized atherosclerosis. The MESA population included a population-based sample of 4 ethnic groups (12% Chinese, 38% white, 22% Hispanic, and 28% black) of 6,814 women and men 45 to 84 years of age. Computed tomographic scans were performed for all participants. The calcium score of each lesion was calculated by multiplying lesion area by a density factor derived from maximal Hounsfield units. A total calcium score was determined by summing individual lesion scores at each anatomic site. Relative risk regression was used to model the probability of MAC as a function of CAC >0 and CAC categories (0, 1 to 99, 100 to 399, and ≥400) with the referent group being CAC 0. The final study population consisted of 6,814 subjects (mean age 62 ± 10 years, 47% men). Overall 9% and 50% had detectable MAC and CAC, respectively. Of those with absent CAC, only 4% had MAC, whereas 9%, 19%, and 15% had MAC scores with increasing CAC scores of 1 to 99, 100 to 399, and ≥400, respectively (p <0.0001 for trend). After taking into account demographics and other risk factors, the prevalence ratio of MAC in those with mild CAC (1 to 99) was 2.13 (95% confidence interval 1.69 to 2.69) and increased to 7.57 (95% confidence interval 5.95 to 9.62) for CAC ≥400. Similar statistically significant increased risk of MAC was found when CAC was assessed as a continuous variable. In conclusion, we observed a strong association between MAC and increasing burden of CAC. This association weakened but persisted after adjustment for age, gender, and other traditional cardiovascular risk factors. These findings suggest that presence of MAC is an indicator of atherosclerotic burden rather than just a degenerative change of the mitral valve.

Section snippets

Methods

MESA patients with baseline MAC and CAC computed tomographic (CT) scans were studied. Patients on dialysis were excluded from the study. The MESA cohort consists of 6,814 men and women 45 to 84 years of age who were recruited from 6 communities in the United States and were free of clinically evident CVD at time of enrollment. The main objective of MESA is to determine characteristics of subclinical CVD and its progression. Participants were excluded if they had a history of coronary bypass

Results

The study population consisted of 6,814 subjects with no previous coronary disease. Cohort participants were 38% white (n = 2,622), 28% black (n = 1,894), 22% Hispanic (n = 1493), and 12% Chinese (n = 803). MAC was present in 644 (9%) of the cohort and CAC was present in 3,398 (50%) of the study cohort.

Baseline characteristics concerning presence/absence of MAC are listed in Table 1. Subjects with MAC were significantly more likely to be older, women, white, had a higher prevalence of

Discussion

Our study demonstrates that MAC is independently associated with increasing severity of coronary atherosclerosis as measured by CAC in all racial groups. This relation persisted even after taking into account age, gender, and other traditional coronary heart disease risk factors. Prevalence of CAC appears to follow a pattern similar to that of coronary heart disease, with a strongly increasing prevalence with age and much higher prevalence in men compared to women.7 Coronary calcium has also

Acknowledgment

The authors thank the other investigators, staff, and participants of the MESA study for their valuable contributions. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org.

References (26)

  • Y. Adler et al.

    Usefulness of helical computed tomography in detection of mitral annular calcification as a marker of coronary artery disease

    Int J Cardiol

    (2005)
  • W.S. Aronow et al.

    Prevalence of echocardiographic findings in 554 men and in 1,243 women aged >60 years in a long-term health care facility

    Am J Cardiol

    (1997)
  • E. Acarturk et al.

    Mitral annular calcification and aortic valve calcification may help in predicting significant coronary artery disease

    Angiology

    (2003)
  • Cited by (49)

    • Correlation between echocardiographic calcium score and coronary artery lesion severity on invasive coronary angiography

      2021, Indian Heart Journal
      Citation Excerpt :

      Atar S et al reported that a higher prevalence of severe CAD in patients with MAC than in those without (88% v 68%, p = 0.0004), and a higher prevalence of left main coronary artery disease (14% v 4%, p = 0.009) and triple vessel disease (54% v 33%, p = 0.002).30 Harnirani YS et al also showed a strong association between MAC and CAD.31 Conte L et al reported that the presence of AVS, in patients admitted for chest pain (with normal cardiac enzymes), was a strong predictor of obstructive CAD, independent of other CAD risk factors.32

    View all citing articles on Scopus

    This research was supported by Grant R01 HL071739 and Contracts N01-HC-95159 through N01-HC-95165 and N01-HC-95169 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland.

    View full text