Tenenbaum A, Shemesh J, Fisman E Z, Motro M
Cardiac Rehabilitation Institute, the Chaim Sheba Medical Center, Tel-Hashomer, Israel.
Invest Radiol. 2000 Mar;35(3):193-8. doi: 10.1097/00004424-200003000-00006.
Mitral annular calcification (MAC) may be a form of atherosclerosis and can lead to serious clinical consequences. The possible linkage between the presence and extent of MAC and coronary calcium score on CT is unknown. The goal of the present study was to investigate whether an association between MAC and coronary calcification (CC) exists in hypertensive patients with increased cardiovascular risk.
Five hundred twenty-two patients (284 men and 238 women, age range 52-80 years, mean 65+/-6 years), who were recruited to the INSIGHT study in the authors' region, underwent fast spiral CT of the heart as well as an echo Doppler examination. MAC was defined as advanced when the thickness of the calcium deposit was 5 mm or more; it was defined as trivial otherwise.
The advanced MAC group comprised 62 patients, the trivial MAC group 215 patients, and the control group (without MAC) 245 patients. The prevalence of nonsevere CC was similar among the study groups, whereas the prevalence of severe CC (total calcium score >300) and the prevalence of proven coronary artery disease were associated with the presence and extent of MAC: respectively, 12% and 15% in control patients, 18% and 20% in patients with trivial MAC, and 29% and 29% in patients with advanced MAC. Multivariate analysis identified advanced MAC as an independent variable associated with severe CC and proved coronary artery disease.
The results of this study demonstrated an association of advanced MAC and severe CC on spiral CT and proved coronary artery disease on the clinical level. Thus, advanced but not trivial MAC makes the noninvasive diagnosis of coronary atherosclerosis more likely and presumably could be considered as a new indication for further coronary evaluation in high-risk patients.
二尖瓣环钙化（MAC）可能是动脉粥样硬化的一种形式，并可导致严重的临床后果。MAC的存在及程度与CT上冠状动脉钙化评分之间的可能联系尚不清楚。本研究的目的是调查心血管风险增加的高血压患者中MAC与冠状动脉钙化（CC）之间是否存在关联。
作者所在地区入选INSIGHT研究的522例患者（284例男性和238例女性，年龄范围52 - 80岁，平均65±6岁）接受了心脏快速螺旋CT及超声多普勒检查。当钙沉积厚度≥5mm时，MAC被定义为重度；否则定义为轻度。
重度MAC组62例患者，轻度MAC组215例患者，对照组（无MAC）245例患者。研究组间非重度CC的患病率相似，而重度CC（总钙化评分>300）的患病率及确诊冠心病的患病率与MAC的存在及程度相关：对照组分别为12%和15%，轻度MAC患者为18%和20%，重度MAC患者为29%和29%。多变量分析确定重度MAC是与重度CC及确诊冠心病相关的独立变量。
本研究结果表明螺旋CT上重度MAC与重度CC相关，且在临床层面与确诊冠心病相关。因此，重度而非轻度MAC使冠状动脉粥样硬化的无创诊断更有可能，并且大概可被视为高危患者进一步冠状动脉评估的新指征。
