Boon A, Lodder J, Cheriex E, Kessels F
Department of Neurology, St Anna Hospital, Geldrop, The Netherlands.
J Neurol. 1997 Sep;244(9):535-41. doi: 10.1007/s004150050140.
All studies but one in the past have shown a strong relative risk of mitral annulus calcification for stroke, but the contribution of associated cardiac and vascular risk factors, especially carotid atheroma has not been appreciated. We studied the risk of stroke in selected patients with mitral annular calcification, adjusting for clinical, echocardiographic and therapeutic factors influencing stroke risk. Of 8,160 consecutive patients with echocardiograms, 657 with and 562 without mitral annulus calcification were followed for a mean of 2.4 years (range 1-6.6) to determine stroke risk by means of proportional hazards models with clinical, echocardiographic, and therapeutic variables that influence the risk of stroke. We also determined the association of mitral annulus calcification with subtypes of ischaemic brain lesions generally considered to be specific for an underlying cardioembolic cause. We therefore distinguished between territorial, small deep, and asymptomatic (silent) brain infarcts. Fifty-one patients with mitral annulus calcification and 27 controls had a stroke in the follow-up period. Mitral annulus calcification was not significantly associated with stroke in proportional hazards models (hazard ratio 0.76, 95% confidence interval 0.42-1.36, P = 0.3), or with any of the stroke subtypes, or with the presence of silent brain infarcts after adjustments for risk factors for generalized vascular disease Hypertension and carotid atheroma, with or without stenosis, ipsilateral or contralateral to the side of the stroke, were significantly associated with stroke in our patients. This study does not support the view that mitral annulus calcification is a risk factor for stroke. As others have found strong associations between mitral annulus calcification and cardiac and vascular risk factors for stroke, the increased risk of stroke in patients with mitral annulus calcification reported may be explained by these confounding risk factors. Therefore, in our opinion, mitral annulus calcification requires treatment of cardiovascular risk factors, but generally no specific measures such as surgery or oral anticoagulants are required to lower the risk of stroke.
过去除一项研究外的所有研究均表明二尖瓣环钙化与中风存在很强的相对风险，但相关心脏和血管危险因素的作用，尤其是颈动脉粥样硬化的作用尚未得到重视。我们研究了选定的二尖瓣环钙化患者的中风风险，并对影响中风风险的临床、超声心动图和治疗因素进行了校正。在连续8160例接受超声心动图检查的患者中，对657例有二尖瓣环钙化和562例无二尖瓣环钙化的患者进行了平均2.4年（范围1 - 6.6年）的随访，通过比例风险模型，利用影响中风风险的临床、超声心动图和治疗变量来确定中风风险。我们还确定了二尖瓣环钙化与通常被认为是潜在心源性栓塞病因所特有的缺血性脑病变亚型之间的关联。因此，我们区分了区域性、小的深部和无症状（隐匿性）脑梗死。51例有二尖瓣环钙化的患者和27例对照在随访期间发生了中风。在比例风险模型中，二尖瓣环钙化与中风无显著关联（风险比0.76，95%置信区间0.42 - 1.36，P = 0.3），与任何中风亚型或隐匿性脑梗死的存在也无关联，在对全身性血管疾病的危险因素高血压和颈动脉粥样硬化（无论有无狭窄，同侧或对侧于中风侧）进行校正后，这些因素在我们的患者中与中风显著相关。本研究不支持二尖瓣环钙化是中风危险因素这一观点。由于其他人发现二尖瓣环钙化与中风的心脏和血管危险因素之间有很强的关联，所报道的二尖瓣环钙化患者中风风险增加可能由这些混杂的危险因素来解释。因此，我们认为，二尖瓣环钙化需要对心血管危险因素进行治疗，但一般不需要采取手术或口服抗凝剂等特定措施来降低中风风险。
