Mitral annular calcification, aortic valve sclerosis and aortic root calcification as a predictor for coronary artery disease

ABSTRACT

Mitral annular calcification [MAC], aortic valve sclerosis [AVS], and aortic root calcification [ARC] are degenerative disease associated with the same risk factors for CAD. Histological and biochemical studies suggests similarities between the mechanisms involved in the development of [MAC, AVS and ARC] and atherosclerosis, suggesting that various calcification processes are part of the spectrum of atherosclerosis and degenerative diseases. This study aimed at evaluation of MAC, AVS and ARC detected by transthoracic echocardiography as a marker for high prevalence of coronary artery disease and to study there to predict the presence of CAD. This study included 50 patients, 30 males and 20 females with mean age of 57.8 +/- 8.5 years. All Patients were subjected to Careful History taking and Thorough clinical examination, Resting 12 leads surface ECG, Chest X ray, Laboratory investigation for diabetes mellitus and hyperlipidemias, Exercise stress test, Coronary angiography and Complete Echocardiographic study with special comment on MAC, AVS, ARC and calculation of the Calcium Deposits Score. Subjects were classified into five groups, Group [1] patients MAC alone, Group [2] patients with AVS alone, Group [3] patients with ARC alone, Group [4] patients with two of the above and Group [5] with All of the above. There was significant difference between patients with and without MAC as regards the incidence of DM and HPN [P < 0.05]. Also the age was higher in patients with MAC [61.6 +/- 7.6 vs. 57.6 +/- 8.5 years] but this difference did not reach statistically significant level [P > 0.05]. The incidence of three vessel disease was significantly higher in patients with MAC [P < 0.05]. The calculated sensitivity of MAC in prediction of CAD was 50%, specificity was 100%, predictive value positive was 100%, predictive value negative was 33.3% and total accuracy was 60% This relatively low sensitivity means that the absence of MAC could not exclude the presence of CAD but the presence of MAC strongly suggest CAD even Severe CAD can be predicted if there is MAC [increased incidence of three vessel disease in patients with MAC]. There was significant difference between patients with and without AVS as regards the age and sex [P < 0.05]. The incidence of DM [77.8% vs. 64.3%], HPN [69.4% vs. 57.1%] smoking [33.3% vs. 7%] was higher in patients with AVS but these differences did not reach statistically significant level [P > 0.05]. The calculated Sensitivity of AVS for prediction of CAD was 75%, specificity 40%, predictive value positive 83.3% and negative 28.5% and accuracy 68%. There was significant difference between patients with and without ARC as regards the incidence of HPN, single and two vessel disease in coronary angiography [P < 0.05]. Although the patients was older [60.1 + 8.3 vs. 58 + 8.3 years], the incidence of dyslepidemia [86.7% vs. 70%] was higher in patients with ARC than patients without ARC, yet these differences did not reach statistically significant level. The calculated Sensitivity of ARC in prediction of CAD was 65%, specificity 60%, predictive value positive 86.7% and negative 30% and accuracy 64%. There was significant difference between patients with different scores regarding the age, incidence of normal coronary angiography, single vessel, two vessels and three vessel disease in coronary angiography. [P < 0.05] the calculated Sensitivity of calcium deposit score one [stated above in MAC, AVS and ARC], but when there is more than one site of calcification [score 2 and 3] the Sensitivity, specificity, predictive value positive, predictive value negative and accuracy all reach 100% for detecting CAD even in the presence of negative exercise stress test. The presence of MAC, AVS, and/or ARC detected by TTE are simple, noninvasive method for prediction of the presence of CAD with accepted sensitivity, specificity, predictive value positive, predictive value negative and accuracy. And when there is more than one site of calcification [calcium deposit score 2 or 3] the sensitivity, specificity, predictive value positive, predictive value negative and accuracy reach 100% for detection of CAD