Convergence between severity of Coronary Artery Disease and mitral annular calcification

Abd El Hamid Ismail Abd El Hamid; Kamal Ahmed Marghany Mhgoub; Moustafa Mohamed Eldeib; Ahmed Mahmoud Mansy; Mohamed Ibrahim Abd  Elnabi; Ahmed Mohammed  Abd El Rhman

Convergence between severity of Coronary Artery Disease and mitral annular calcification

Authors

Abd El Hamid Ismail Abd El Hamid Cardiology Department, Faculty of Medicine, Al-Azhar University, Egypt
Kamal Ahmed Marghany Mhgoub Cardiology Department, Faculty of Medicine, Al-Azhar University, Egypt
Moustafa Mohamed Eldeib Cardiology Department, Faculty of Medicine, Al-Azhar University, Egypt
Ahmed Mahmoud Mansy Cardiology Department, Faculty of Medicine, Al-Azhar University, Egypt
Mohamed Ibrahim Abd Elnabi Cardiology Department, Faculty of Medicine, Al-Azhar University, Egypt
Ahmed Mohammed Abd El Rhman Cardiology Department, Faculty of Medicine, Al-Azhar University, Egypt

Keywords:

Mitral Annular Calcification, Coronary Calcium Score, Coronary Artery Disease, Atherosclerosis

Abstract

Background: There is a well-established link between coronary artery calcium (CAC) score on computed tomography and the severity of coronary atherosclerosis. Cardiovascular events and mitral valve dysfunction are related to mitral annular calcification (MAC).

Objectives: This study aimed to detect the relationship between MAC detected by TTE and coronary calcium score (CCS) and the relation between MAC and extent of coronary artery disease (CAD) by computed tomography (CT).

Methods: This prospective cross-sectional study comprised 100 patients with symptoms of intermediate likelihood stable CAD and indicated for coronary CT angiography according to ESC guideline. Study participants were categorized into three main groups where Group I included: 50 patients without mitral annular calcification (control group). Group II: included 50 patients with mitral annular calcification. Then the participants of group II were sub-grouped into IIa group which included patients with mild MAC and group IIb which included patients with moderate to severe MAC.

Results: There was significant difference between 3 studied groups in ischemic heart disease (IHD) detected by electrocardiogram, calcium score, type of atherosclerotic CAD. In addition, MAC score is a good predicator for obstructive CAD (AUC =0.830, 95% CI =0.636 - 0.946, p value <0.001), with 100% sensitivity and 61.54% specificity. Coronary artery calcium (CAC) score is a good predicator for obstructive CAD (AUC =0.775, 95% CI =0.574 -0.912, p value =0.009), with 100% sensitivity and 61.54% specificity. Multivariate logistic regression showed that MAC was a good predictor for the presence of CAD (p =0.008).

Conclusions: We discovered a strong connection between MAC and CAC and higher CAD burden. These data demonstrate that the existence of MAC is an indication of atherosclerosis instead of simply a degenerative alteration in the mitral valve.

Convergence between severity of Coronary Artery Disease and mitral annular calcification