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European Heart Journal Advance Access originally published online on April 28, 2008
European Heart Journal 2008 29(12):1542-1547; doi:10.1093/eurheartj/ehn172
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Association of mitral annular calcification and aortic valve morphology: a substudy of the aortic stenosis progression observation measuring effects of rosuvastatin (ASTRONOMER) study

Davinder S. Jassal1,2,3,*, James W. Tam1, Kapil M. Bhagirath1, Isabelle Gaboury4, Randall A. Sochowski5, Jean G. Dumesnil6, Peter J. Giannoccaro7, John Jue8, A. Shekhar Pandey9, Campbell D. Joyner10, Koon K. Teo11 and Kwan L. Chan12

1 Cardiology Division, Department of Cardiac Sciences, St Boniface General Hospital, Rm Y3010, 409 Tache Avenue, Winnipeg, Manitoba, Canada R2H 2A6
2 Institute of Cardiovascular Sciences, Cardiology Division, Department of Cardiac Sciences, St Boniface General Hospital, Winnipeg, Manitoba, Canada
3 Department of Radiology, St. Boniface General Hospital, Winnipeg, Manitoba, Canada
4 Clinical Research Unit, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
5 Victoria Heart Institute Foundation, Victoria, British Columbia, Canada
6 Hopital Laval, Sainte-Foy, Quebec, Canada
7 Peter Lougheed Centre, Calgary, Alberta, Canada
8 Vancouver General Hospital, Vancouver, British Columbia, Canada
9 Cambridge Cardiac Care Centre, Cambridge, Ontario, Canada
10 Sunnybrook HSC, Toronto, Ontario, Canada
11 McMaster University, Hamilton, Ontario, Canada
12 University of Ottawa Heart Institute, Ontario, Canada

Received 21 December 2007; revised 6 March 2008; accepted 7 April 2008; online publish-ahead-of-print 28 April 2008.

* Corresponding author. Tel: +1 204 237 2023, Fax: +1 204 233 2157, Email: djassal{at}sbgh.mb.ca

See page 1478 for the editorial comment on this article (doi:10.1093/eurheartj/ehn226)

Aims: Mitral annular calcification (MAC) is characterized by calcium and lipid deposition in the annular fibrosa of the mitral valve. Although individuals with MAC are at increased risk of cardiovascular events, little is known about the significance of this finding in patients with concurrent aortic stenosis (AS). The aim of this study was to describe the association of baseline MAC and aortic valve morphology in asymptomatic patients enrolled in the ASTRONOMER study, a multicentre study to assess the effect of Rosuvastatin on the progression of AS.

Methods and results: At baseline, transthoracic echocardiography was performed with two-dimensional and Doppler imaging following a standardized protocol. Echo measurements including left ventricular (LV) dimensions and aortic root dimensions were obtained according to the ASE recommendations. MAC was identified by bright echoes at the base of the mitral leaflets or annulus on 2D imaging, and aortic valve calcification by visualization of bright echoes on the aortic valve leaflets. The degree of calcification was semi-quantitated from absent to severe. The study population included 219 patients (57 ± 14 years; 129 males), divided into two pre-specified categories; bicuspid (n = 133) and tricuspid (n = 86) aortic valves. Baseline LV dimensions, aortic valve haemodynamics, and cholesterol profiles were similar between the two groups at baseline. Individuals with tricuspid aortic valves were older, more hypertensive, with higher degrees of MAC and AV calcification (P < 0.001). The higher degree of MAC persisted in patients with tricuspid AV after adjustment for age and systolic blood pressure (P = 0.004).

Conclusion: In patients with asymptomatic mild to moderate AS, MAC is more prevalent in those individuals with tricuspid AV, independent of age, and systolic blood pressure. Whether the degree of MAC may be a surrogate for atherosclerosis, and predict the subset of patients who will respond to statin therapy in preventing the progression of AS, remains to be determined.

Key Words: Mitral annular calcification • Aortic valve calcification • Aortic stenosis


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