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Mitral annular calcification (MAC) has been proposed as a risk of atherosclerotic disease, which may be used as a risk marker for CAD.
Aim of study
To compare the CAD risk associated between the presence and the absence of MAC in patients with aortic valve sclerosis (AVS).
Patients and Methods
Sixty patients with suspected coronary artery disease with aortic valve sclerosis and/or mitral annular calcification, referred for diagnostic coronary angiography for evaluation of chest pain between January 2015 and April 2017. Patients were divided into: Group I - 30patients with aortic valve sclerosis and Group II - 30 patients with aortic valve sclerosis and mitral annulus calcification. Inclusion criteria: Less than 65 years – patients indicated for coronary angiography. Exclusion criteria: aortic stenosis,rheumatic or congenital aortic valves,hyperparathyroidism, hemodialysis.
All patients were subjected to history, clinical, lab assessment, ECG, and echo evaluation. AVS were defined as a focal area of increased echogenicity and thickening of the aortic valve leaflets without restriction of leaflet motion and a transaortic flow velocity (<2.5 m.s) on TTE. MAC was defined as intense echo-producing structure located at the junction of the atrio-ventricular groove and posterior mitral leaflet in parasternal long axis view,measured in millimeters from the leading anterior to the trailing posterior edge and quantified as mild to moderate (1 to 4 mm) and severe (>4 mm) considering its thickness. Diagnostic angiograpghy were done to all patients evaluated by two observers, which were graded according to Friesinger score. This ranges from 0 to 15. Each of the three main coronary arteries is scored separately from 0 to 5. Score 0: No arteriographic abnormality, Score 1: Trivial irregularities (lesion from 1-29%), Score 2: Localized 30-68% luminal narrowing, Score 3: Multiple 30-68% luminal narrowing of same vessel, Score 4: 69-100% luminal narrowing without 100% occlusion of proximal segments, and Score 5: Total obstruction of a proximal segment of a vessel.
According to Friesinger score, there was high statistically significant difference (mean ± SD was 7.3 ± 2.87 %in group I, and 9.53 ± 2.36% in group II) (P <0.001). Friesinger score (r=0.75) and Leaman score(r=0.42).
MAC can be an independent predictor of significant CAD and there is positive correlation between severity of MAC and severity of CAD.