Mitral Annular Calcification Linked With Severe Obstructive Coronary Artery Disease

Mitral annular calcification is associated with an increased prevalence of severe obstruction coronary artery disease, according to a report in the February issue of Heart.

“Mitral annular calcification has been associated with various systemic and cardiac diseases, with a higher prevalence in women and patients over 70,” Dr. Robert J. Siegel and colleagues from Cedars-Sinai Medical Center, Los Angeles, California, note. “A possible association between mitral annular calcification and coronary artery disease has recently been suggested.”

To investigate, the researchers examined the prevalence of severe coronary artery disease in patients 65 years old or younger with mitral annular calcification. Overall, 17,735 consecutive patients with and without mitral annular calcification were screened.

Dr. Siegel’s group found that 6207 (35%) of those screened had mitral annular calcification. Of these patients, 885 (5%) were also 65 years or younger. One hundred who underwent coronary angiography were included in the study and 121 patients served as controls.

Eighty-eight percent of patients with mitral annular calcification had severe coronary artery disease, compared with 68% of those without mitral annular calcification (p = 0.0004). Left main coronary artery disease (14% versus 4%, p = 0.009) and triple vessel disease (54% versus 33%, p = 0.002) were also more prevalent among those with mitral annular calcification.

“The presence of mitral annular calcification on transthoracic echocardiography was found to have a 92% positive predictive value for the presence of significant coronary artery disease, while the absence of mitral annular calcification had a 49% negative predictive value,” Dr. Siegel and colleagues report.

Based on these findings, they suggest that mitral annular calcification may be a useful marker of significant obstructive coronary artery disease in patients 65 years of age or younger.

Heart 2003;89:161-164.