Association between mitral annulus calcification and peripheral arterial atherosclerotic disease

The authors previously demonstrated a significant association between the p resence of mitral annulus calcification (MAC) and aortic atheroma, carotid atherosclerotic disease, and coronary artery disease. The present study was designed to determine whether an association exists between MAC and periph eral arterial atherosclerotic disease. Of the 805 patients in whom the diagnosis of MAC was made by transthoracic echocardiography between 1995 and 1997, 77 patients (40 men and 37 women; m ean age, 73.1 +/- 11.4 years; range, 44-90 years) underwent peripheral arte rial testing for various indications, and comprised the study group. They w ere compared with 58 age-matched and sex-matched patients without MAC (30 m en and 28 women; mean age, 73.2 +/- 11.8 years; range, 31-93 years) who und erwent peripheral arterial testing during the same period for the same indi cations (control group). MAC was defined as a dense, localized, highly refl ective area at the base of the posterior mitral leaflet detected by transth oracic echocardiography. An ankle/brachial systolic pressure index (ABI) wa s calculated by dividing the higher dorsalis pedis or posterior tibial Dopp ler-derived pressures by the higher of the 2 upper extremity systolic press ures. ABI was graded as follows: normal greater than or equal to 1, abnorma l < 1, mild 0.71 to 0.99, moderate 0.41 to 0.7, and severe less than or equ al to 0.4. No differences were found between the groups in indications for referral fo r peripheral arterial testing and in risk factors for atherosclerosis excep t for hypertension, which was found to be significantly more prevalent in t he study group (66% vs 41%, p = 0.004). The study group included 151 limbs, and the control group included 113 limbs. The mean ABI was significantly l ower for all limbs in the MAC group (0.56 +/- 0.27 vs 0.87 +/- 0.24, p = 0. 0001), abnormal ABI < 1 (94% vs 68%, p = 0.001), moderate peripheral arteri al disease (44% vs 25%, p = 0.001), and a severe disease (27% vs 1%, p = 0. 001). Of the 77 patients with MAC, 73 (95%) had a disease (right and/or lef t limbs) compared with 40 of 58 (69%) in the control group (p = 0.001). Bil ateral disease (Doppler index <1 for both right and left limbs), and severe bilateral disease (Doppler index I 0.4 for both right and left limb) were also found to be significantly more prevalent in the MAC group (87% vs 60%, p = 0.001; and 12% vs 0%, p = 0.007, respectively). There is a significant association between the presence of MAC and peripher al arterial disease. This information strengthens our hypothesis that MAC m ay be an important marker for generalized vascular atherosclerotic disease.