Adler Y, Herz I, Vaturi M, Fusman R, Shohat-Zabarski R, Fink N, Porter A, Shapira Y, Assali A, Sagie A
Department of Cardiology, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel.
Am J Cardiol. 1998 Nov 15;82(10):1183-6. doi: 10.1016/s0002-9149(98)00596-7.
This study tests the hypothesis that mitral annular calcium (MAC) detected by transthoracic echocardiography (TTE) is a marker for high prevalence and severity of coronary artery disease (CAD) in patients undergoing coronary angiography. Pathological studies have suggested that there is an association between MAC and calcific deposits in coronary arteries; however, there are no clinical data to support this association. One hundred sixty-five patients with MAC (101 women and 64 men; mean age 71 +/- 8 years) who underwent cardiac catheterization with coronary angiography for various reasons were compared with 147 age-matched controls without MAC who underwent coronary angiography for the same indications during the same period. MAC was defined as a dense, localized, highly reflective area at the base of the posterior mitral leaflet detected by TTE. Obstructive CAD was defined as either > or = 50% reduction of the internal diameter of the left main coronary artery or > or = 70% reduction of the internal diameter of the left anterior descending, right coronary, or left circumflex artery distribution. Compared with controls, the MAC group had a significantly higher prevalence of CAD (89% vs 75%, p = 0.001) and higher rates of 3-vessel disease (45% vs 24%, p = 0.001) and left main CAD (13% vs 5%, p = 0.009). Nonsignificant CAD was more common in the control group (25% vs 11%, p = 0.001). Multivariate analysis identified MAC (p = 0.0002), indications for cardiac angiography (p = 0.02), sex (p = 0.03), and diabetes mellitus (p = 0.03) as independent predictors for the presence and severity of obstructive CAD. MAC detected by TTE may be a marker for high prevalence and severity of CAD in patients undergoing coronary angiography.
本研究检验了经胸超声心动图（TTE）检测到的二尖瓣环钙化（MAC）是接受冠状动脉造影患者中冠状动脉疾病（CAD）高患病率和严重程度的标志物这一假设。病理研究表明MAC与冠状动脉钙化沉积之间存在关联；然而，尚无临床数据支持这一关联。将165例因各种原因接受心脏导管插入术及冠状动脉造影的MAC患者（101例女性和64例男性；平均年龄71±8岁）与147例同期因相同适应证接受冠状动脉造影的年龄匹配的无MAC对照组进行比较。MAC定义为TTE检测到的二尖瓣后叶基部的致密、局限性、高回声区。阻塞性CAD定义为左主冠状动脉内径减少≥50%或左前降支、右冠状动脉或左旋支动脉分布内径减少≥70%。与对照组相比，MAC组CAD患病率显著更高（89%对75%，p = 0.001），三支血管病变发生率更高（45%对24%，p = 0.001），左主干CAD发生率更高（13%对5%，p = 0.009）。非显著性CAD在对照组中更常见（25%对11%，p = 0.001）。多变量分析确定MAC（p = 0.0002）、心脏血管造影适应证（p = 0.
