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Distribution of Mitral Annular and Aortic Valve Calcium as Assessed by Unenhanced Multidetector Computed Tomography

Published:October 06, 2015DOI:https://doi.org/10.1016/j.amjcard.2015.09.037
      Aging is associated with calcium deposits in various cardiovascular structures, but patterns of calcium deposition, if any, are unknown. In search of such patterns, we performed quantitative assessment of mitral annular calcium (MAC) and aortic valve calcium (AVC) in a broad clinical sample. Templates were created from gated computed tomography (CT) scans depicting the aortic valve cusps and mitral annular segments in relation to surrounding structures. These were then applied to CT reconstructions from ungated, clinically indicated CT scans of 318 subjects, aged ≥65 years. Calcium location was assigned using the templates and quantified by the Agatston method. Mean age was 76 ± 7.3 years; 48% were men and 58% were white. Whites had higher prevalence (p = 0.03) and density of AVC than blacks (p = 0.02), and a trend toward increased MAC (p = 0.06). Prevalence of AVC was similar between men and women, but AVC scores were higher in men (p = 0.008); this difference was entirely accounted for by whites. Within the aortic valve, the left cusp was more frequently calcified than the others. MAC was most common in the posterior mitral annulus, especially its middle (P2) segment. For the anterior mitral annulus, the medial (A3) segment calcified most often. In conclusion, AVC is more common in whites than blacks, and more intense in men, but only in whites. Furthermore, calcium deposits in the mitral annulus and aortic valve favor certain locations.
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      References

        • Roberts W.C.
        The senile cardiac calcification syndrome.
        Am J Cardiol. 1986; 58: 572-574
        • Fox C.S.
        • Larson M.G.
        • Vasan R.S.
        • Guo C.Y.
        • Parise H.
        • Levy D.
        • Leip E.P.
        • O'donnell C.J.
        • D'Agostino R.B.
        • Benjamin E.J.
        Cross-sectional association of kidney function with valvular and annular calcification: the Framingham Heart Study.
        J Am Soc Nephrol. 2006; 17: 521-527
        • Kohsaka S.
        • Jin Z.
        • Rundek T.
        • Boden-Albala B.
        • Homma S.
        • Sacco R.L.
        • Di Tullio M.R.
        Impact of mitral annular calcification on cardiovascular events in a multiethnic community: the Northern Manhattan Study.
        JACC Cardiovasc Imaging. 2008; 1: 617-623
        • Benjamin E.J.
        • Plehn J.F.
        • D'Agostino R.B.
        • Belanger A.J.
        • Comai K.
        • Fuller D.L.
        • Wolf P.A.
        • Levy D.
        Mitral annular calcification and the risk of stroke in an elderly cohort.
        N Engl J Med. 1992; 327: 374-379
        • Fox C.S.
        • Parise H.
        • Vasan R.S.
        • Levy D.
        • O'Donnell C.J.
        • D'Agostino R.B.
        • Plehn J.F.
        • Benjamin E.J.
        Mitral annular calcification is a predictor for incident atrial fibrillation.
        Atherosclerosis. 2004; 173: 291-294
        • Muddassir S.M.
        • Pressman G.S.
        Mitral annular calcification as a cause of mitral valve gradients.
        Int J Cardiol. 2007; 123: 58-62
        • Pressman G.S.
        • Agarwal A.
        • Braitman L.E.
        • Muddassir S.M.
        Mitral annular calcium causing mitral stenosis.
        Am J Cardiol. 2010; 105: 389-391
        • Fulkerson P.K.
        • Beaver B.M.
        • Auseon J.C.
        • Graber H.L.
        Calcification of the mitral annulus: etiology, clinical associations, complications and therapy.
        Am J Med. 1979; 66: 967-977
        • Carpentier A.F.
        • Lessana A.
        • Relland J.Y.
        • Belli E.
        • Mihaileanu S.
        • Berrebi A.J.
        • Palsky E.
        • Loulmet D.F.
        The “physio-ring”: an advanced concept in mitral valve annuloplasty.
        Ann Thorac Surg. 1995; 60: 1176-1185
        • Fusini L.
        • Ghulam Ali S.
        • Tamborini G.
        • Muratori M.
        • Gripari P.
        • Maffessanti F.
        • Celeste F.
        • Guglielmo M.
        • Cefalù C.
        • Alamanni F.
        • Zanobini M.
        • Pepi M.
        Prevalence of calcification of the mitral valve annulus in patients undergoing surgical repair of mitral valve prolapse.
        Am J Cardiol. 2014; 113: 1867-1873
        • Agatston A.S.
        • Janowitz W.R.
        • Hildner F.J.
        • Zusmer N.R.
        • Viamonte M.
        • Detrano R.
        Quantification of coronary artery calcium using ultrafast computed tomography.
        J Am Coll Cardiol. 1990; 15: 827-832
        • Aggarwal S.R.
        • Clavel M.A.
        • Messika-Zeitoun D.
        • Cueff C.
        • Malouf J.
        • Araoz P.A.
        • Mankad R.
        • Michelena H.
        • Vahanian A.
        • Enriquez-Sarano M.
        Sex differences in aortic valve calcification measured by multidetector computed tomography in aortic stenosis.
        Circ Cardiovasc Imaging. 2013; 6: 40-47
        • Patel D.K.
        • Green K.D.
        • Fudim M.
        • Harrell F.E.
        • Wang T.J.
        • Robbins M.A.
        Racial differences in the prevalence of severe aortic stenosis.
        J Am Heart Assoc. 2014; 3: e000879
        • Cueff C.
        • Serfaty J.M.
        • Cimadevilla C.
        • Laissy J.P.
        • Himbert D.
        • Tubach F.
        • Duval X.
        • Iung B.
        • Enriquez-Sarano M.
        • Vahanian A.
        • Messika-Zeitoun D.
        Measurement of aortic valve calcification using multislice computed tomography: correlation with haemodynamic severity of aortic stenosis and clinical implication for patients with low ejection fraction.
        Heart. 2011; 97: 721-726
        • Haensig M.
        • Lehmkuhl L.
        • Rastan A.J.
        • Kempfert J.
        • Mukherjee C.
        • Gutberlet M.
        • Holzhey D.M.
        • Mohr F.W.
        Aortic valve calcium scoring is a predictor of significant paravalvular aortic insufficiency in transapical-aortic valve implantation.
        Eur J Cardiothorac Surg. 2012; 41: 1231-1240
        • Haensig M.
        • Rastan A.J.
        Aortic valve calcium load before tavi: is it important?.
        Ann Cardiothorac Surg. 2012; 1: 160-164
        • Kanjanauthai S.
        • Nasir K.
        • Katz R.
        • Rivera J.J.
        • Takasu J.
        • Blumenthal R.S.
        • Eng J.
        • Budoff M.J.
        Relationships of mitral annular calcification to cardiovascular risk factors: the Multi-Ethnic Study of Atherosclerosis (MESA).
        Atherosclerosis. 2010; 213: 558-562
        • Cujec B.
        • Pollick C.
        Isolated thickening of one aortic cusp: preferential thickening of the noncoronary cusp.
        J Am Soc Echocardiogr. 1988; 1: 430-432
        • Dagum P.
        • Green G.R.
        • Nistal F.J.
        • Daughters G.T.
        • Timek T.A.
        • Foppiano L.E.
        • Bolger A.F.
        • Ingels Jr., N.B.
        • Miller D.C.
        Deformational dynamics of the aortic root: modes and physiologic determinants.
        Circulation. 1999; 10: II54-II62
        • Grande K.J.
        • Cochran R.P.
        • Reinhall P.G.
        • Kunzelman K.S.
        Stress variations in the human aortic root and valve: the role of anatomic asymmetry.
        Ann Biomed Eng. 1998; 26: 534-545
        • McCarthy K.P.
        • Ring L.
        • Rana B.S.
        Anatomy of the mitral valve: understanding the mitral valve complex in mitral regurgitation.
        Eur J Echocardiogr. 2010; 11: i3-i9
        • Silbiger J.J.
        Anatomy, mechanics, and pathophysiology of the mitral annulus.
        Am Heart J. 2012; 164: 163-176
        • Sengupta P.P.
        Exploring left ventricular isovolumic shortening and stretch mechanics: “the heart has its reasons…”.
        JACC Cardiovasc Imaging. 2009; 2: 212-215