Key result
A mitral annular calcification score incorporating mobility, caseous necrosis, and functional stenosis was independently associated with prior stroke, with a score of 3 increasing the odds by over 20-fold (OR 20.575).
Why the study?
Mitral annular calcification is associated with stroke risk, but the specific morphological and functional characteristics of MAC related to stroke needed to be defined.
Are high-risk morphological and functional characteristics of mitral annular calcification associated with a history of stroke in patients with MAC?
Case-Control (n=460)
No
Are high-risk morphological and functional characteristics of mitral annular calcification associated with a history of stroke in patients with MAC?
Odds Ratio: 20.575 (95% CI 1.642–257.7)
p-value: p=0.019
A novel echocardiographic MAC score incorporating mobility, caseous necrosis, and functional stenosis is independently associated with a history of stroke, providing incremental value over traditional risk factors.
Should not yet change stroke risk assessment in MAC; leaves open prospective validation of this echocardiographic score.
BACKGROUND: Mitral annular calcification (MAC) is associated with risk of stroke. This study aimed to define the morphological and functional characteristics of MAC that are related to stroke. METHODS: A total of 460 subjects with MAC from transthoracic echocardiography in a single center from 2012 to 2016 was retrospectively reviewed. Subjects were classified into two groups according to history of stroke [Group 1 (n = 366): without stroke; Group 2 (n = 94): with stroke]. Morphological and functional features of MAC on echocardiogram were scored from 0 to 3 according to MAC mobility, presence of echodense mass with central echolucencies in the periannular region suggesting caseous necrosis, and functional stenosis. RESULTS: Significantly more patients in group 2 were men and had history of diabetes mellitus, dyslipidemia, atrial fibrillation, or infective endocarditis. Although MAC thickness and extent did not differ between the two groups, group 2 showed a considerably higher MAC score than group 1 (0.50 ± 0.77 vs. 0.23 ±0.52 p<0.001) as a result of the higher prevalence of each component in group 2 [mobility (22 vs. 11%, p = 0.003), echodense mass with central areas of echolucencies suggesting caseous necrosis (23 vs. 7%, p<0.001), and functional mitral stenosis (12 vs. 7%, p = 0.042)]. On logistic regression analysis, MAC score was independently associated with stroke and showed significant incremental value to demographic factors and comorbidities in association with stroke in a consecutive manner. CONCLUSIONS: In conclusion, morphological and functional characteristics of MAC had incremental value in association with stroke over traditional risk factors. MAC score consisting of MAC mobility, typical echodense mass with central echolucencies suggesting caseous necrosis, and functional mitral stenosis was independently associated with stroke. MAC with high-risk features may act as a source of stroke or more potent composite surrogate markers for stroke-related risk factors.
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Kim et al. (2020) conducted a case-control in Mitral annular calcification (MAC) (n=460). High mitral annular calcification (MAC) score vs. MAC score of 0 was evaluated on Association with previous stroke (MAC score 3 vs 0) (OR 20.575, 95% CI 1.642-257.7, p=0.019). A mitral annular calcification score incorporating mobility, caseous necrosis, and functional stenosis was independently associated with prior stroke, with a score of 3 increasing the odds by over 20-fold (OR 20.575).
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