Rajesh Movva1, Kinnari Murthy1, Abel Romero-Corral1, Harish Raj Seetha Rammohan1, Peter Fumo1, Gregg S Pressman2. 1. Division of Cardiology (R.M., K.M., A.R.-C., H.R.S.R., G.S.P.) and the Division of Nephrology (P.F.), Einstein Medical Center, Philadelphia, Pennsylvania. 2. Division of Cardiology (R.M., K.M., A.R.-C., H.R.S.R., G.S.P.) and the Division of Nephrology (P.F.), Einstein Medical Center, Philadelphia, Pennsylvania. Electronic address: pressmang@einstein.edu.
Abstract
BACKGROUND: Mitral annular calcification (MAC) is common in chronic kidney disease. It is associated with cardiovascular events and can cause valvular dysfunction, but it has not been systematically characterized. The aim of this prospective study was to assess the prevalence and distribution of MAC, its effects on leaflet motion, and its association with mitral stenosis and mitral regurgitation (MR) in a hemodialysis population. METHODS: Echocardiograms were obtained in 75 consecutive hemodialysis outpatients. MAC extent and distribution were graded semiquantitatively using two-dimensional and three-dimensional echocardiography. Associations with the presence and severity of mitral stenosis and MR were explored. RESULTS: The mean age was 60 ± 14 years; 60% were men, and 87% were African American. MAC was present in 64% (moderate to severe in 48%). Calcium extended more than halfway onto the leaflet in 37% and beyond the annulus in 40%. Leaflet motion was restricted in 37%. Mitral stenosis was present in 28%, and the extent of calcification was associated with mean mitral valve gradient (P < .0001). MR was prevalent (present in 81%) but was severe in none. The severity of MAC was greater in patients with moderate MR than in those with no or mild MR (P = .04). Three-dimensional analysis suggested an uneven distribution of annular calcium; the middle and lateral anterior segments were less often calcified than the anterior-medial or posterior segments. Calcification in any annular segment was highly associated with restricted motion of the attached leaflet segment. CONCLUSIONS: MAC is common and often extensive in hemodialysis patients. Calcium may be unevenly distributed among the annular segments. When present, annular calcification reduces the angle of leaflet opening and can cause valvular dysfunction.
BACKGROUND:Mitral annular calcification (MAC) is common in chronic kidney disease. It is associated with cardiovascular events and can cause valvular dysfunction, but it has not been systematically characterized. The aim of this prospective study was to assess the prevalence and distribution of MAC, its effects on leaflet motion, and its association with mitral stenosis and mitral regurgitation (MR) in a hemodialysis population. METHODS: Echocardiograms were obtained in 75 consecutive hemodialysis outpatients. MAC extent and distribution were graded semiquantitatively using two-dimensional and three-dimensional echocardiography. Associations with the presence and severity of mitral stenosis and MR were explored. RESULTS: The mean age was 60 ± 14 years; 60% were men, and 87% were African American. MAC was present in 64% (moderate to severe in 48%). Calcium extended more than halfway onto the leaflet in 37% and beyond the annulus in 40%. Leaflet motion was restricted in 37%. Mitral stenosis was present in 28%, and the extent of calcification was associated with mean mitral valve gradient (P < .0001). MR was prevalent (present in 81%) but was severe in none. The severity of MAC was greater in patients with moderate MR than in those with no or mild MR (P = .04). Three-dimensional analysis suggested an uneven distribution of annular calcium; the middle and lateral anterior segments were less often calcified than the anterior-medial or posterior segments. Calcification in any annular segment was highly associated with restricted motion of the attached leaflet segment. CONCLUSIONS: MAC is common and often extensive in hemodialysis patients. Calcium may be unevenly distributed among the annular segments. When present, annular calcification reduces the angle of leaflet opening and can cause valvular dysfunction.
Authors: Philippe B Bertrand; Timothy W Churchill; Evin Yucel; Mayooran Namasivayam; Samuel Bernard; Yasufumi Nagata; Wei He; Carl T Andrews; Michael H Picard; Arthur E Weyman; Robert A Levine; Judy Hung Journal: Eur Heart J Date: 2020-12-01 Impact factor: 29.983
Authors: Luiz Rafael P Cavalcanti; Michel Pompeu B O Sá; Álvaro M Perazzo; Antonio C Escorel Neto; Rafael A F Gomes; Alexander Weymann; Konstantin Zhigalov; Arjang Ruhparwar; Ricardo C Lima Journal: Curr Atheroscler Rep Date: 2020-02-07 Impact factor: 5.113
Authors: Estibaliz Castillero; Daniel P Howsmon; Bruno V Rego; Samuel J Keeney; Kathryn H Driesbaugh; Takayuki Kawashima; Yingfei Xue (薛应騛); Chiara Camillo; Isaac George; Robert C Gorman; Joseph H Gorman; Michael S Sacks; Robert J Levy; Giovanni Ferrari Journal: Arterioscler Thromb Vasc Biol Date: 2021-04-08 Impact factor: 10.514
Authors: Karina Castellon-Larios; Alix Zuleta-Alarcon; Antolin Flores; Michelle Humeidan; Andrew N Springer; Michael Essandoh Journal: J Investig Med High Impact Case Rep Date: 2014-06-24
Authors: Victor Mauri; Maria I Körber; Elmar Kuhn; Tobias Schmidt; Christian Frerker; Thorsten Wahlers; Tanja K Rudolph; Stephan Baldus; Matti Adam; Henrik Ten Freyhaus Journal: Clin Res Cardiol Date: 2020-02-18 Impact factor: 5.460
Authors: Antonio Bellasi; Paolo Raggi; Jordi Bover; David A Bushinsky; Glenn M Chertow; Markus Ketteler; Mariano Rodriguez; Smeeta Sinha; Carolina Salcedo; Rekha Garg; Alex Gold; Joan Perelló Journal: Clin Kidney J Date: 2019-10-30
Authors: Caius Glad Streian; Ana Lascu; Raluca Şoşdean; Ciprian Nicuşor Dima; Florin Grosu; Adrian Costache; Andrei Gheorghe Marius Motoc Journal: Rom J Morphol Embryol Date: 2020 Apr-Jun Impact factor: 1.033