Association between mitral annulus calcification and aortic atheroma: a prospective transesophageal echocardiographic study

Background and purpose: Although mitral annulus calcification (MAC) has bee n reported to be a significant independent predictor of stroke, no causativ e relationship was proven. It is also known that aortic atheroma (AA), espe cially those greater than or equal to 5 mm thick and/or protruding and/or m obile are associated with stroke. This study was designed to determine whet her an association exists between MAC and AA. Methods: We prospectively eva luated the records of 279 consecutive patients who underwent transesophagea l echocardiography (TEE) for various indications to measure the presence an d characteristics of AA. The 105 patients in whom a diagnosis of MAC was ma de on transthoracic echocardiography (TTE) immediately preceding the TEE, w ere compared with 174 age-matched patients without MAC. MAC was defined as a dense, localized, highly reflective area at the base of the posterior mit ral leaflet. We measured MAC thickness with two-dimensional-TTE in four-cha mber view and AA thickness, protrusion and mobility with TEE. AA was define d as localized intimal thickening of greater than or equal to 3 mm. A lesio n was considered complex if there was plaque extending greater than or equa l to 5 mm into the aortic lumen and/or if it was protruding, mobile or ulce rated. Results: No differences were found between the groups in risk factor s for atherosclerosis or in indications for referral for TEE. Significantly higher rates were found in the MAC group for prevalence of AA (91 vs. 44%, P <0.001), atheromas greater than or equal to 5 mm thick (68 vs. 19%, P < 0.001), protruding atheromas (44 vs. 15%, P < 0.001), ulcerated atheromas ( 10 vs. 1%, P < 0.001) and complex atheroma (74 vs. 22%, P < 0.001). Sixty p atients had MAC thickness greater than or equal to 6 mm and 45 < 6 mm. AA t hickness was significantly greater in the patients with a MAC thickness of greater than or equal to 6 mm (6.1 +/- 2.8 vs. 5.0 +/- 2.6 mm, P = 0.03). O n multivariate analysis MAC, hypertension and age were the only independent predictors of AA (P = 0.0001, 0.005 and 0.007, respectively). Conclusions: There is a significant association between the presence and severity of MA C and AA. MAC may be an important marker for atherosclerosis of the aorta. This association may explain in part the high prevalence of systemic emboli and stroke in patients with MAC. (C) 2000 Elsevier Science Ireland Ltd. Al l rights reserved.