Relationship between the Achilles tendon strain ratio and the presence of mitral annulus calcification

Year 2022, Volume: 47 Issue: 3, 1210 - 1219, 30.09.2022

Burçak Çakır Peköz , Arafat Yıldırım

https://doi.org/10.17826/cumj.1132997

Abstract

Purpose: We aimed to investigate the significance of Achilles tendon (AT) thickness (T) and AT strain ratio (SR), determined by AT ultrasonography (US) and strain elastography (SE), in determining patients with mitral annulus calcification (MAC).
Materials and Methods: 100 patients (65 females, 35 males, mean age 64.7 ± 12.1 years) diagnosed with MAC after echocardiography and 50 control subjects (32 females, 18 males, mean age 63.2 ± 12.8 years) with similar cardiovascular risk factors were included. Laboratory tests and AT US were performed. AT T and AT-SR were calculated.
Results: AT -T and AT-SR were found to be significantly higher in patients with MAC. In multivariate logistic regression analysis, AT -T and AT-SR independently determined the risk for MAC. According to this analysis, AT -T (1 mm each) and AT-SR (0.1 each) increased the risk for MAC by 69.9% and 12.7%, respectively. When ROC was analyzed using AT -T and AT-SR to predict patients with MAC, the areas under the curve (AUC) of ROC were 0.684 and 0.819, respectively. In the same analysis accepting the cut-off value of 1.25 for AT-SR, the presence of MAC was detected with a sensitivity of 94.1% and a specificity of 76.2%.
Conclusion: AT-SR detected in AT SE examination is a simple, reproducible, inexpensive, and noninvasive parameter that can be used to predict patients with MAC. This may be due to the fact that the increase in MAC and AT-SR may be associated with similar physiopathological mechanisms.

Keywords

Achilles tendon strain ratio, mitral annulus calcification, Achilles tendon thickness, strain elastography

Aşil tendonu gerinim oranı ile mitral anulus kalsifikasyonu varlığı arasındaki ilişki

Abstract

Amaç: Aşil tendonu (AT)- ultrasonografisi (US) ve gerinim elastografisi (SE) ile elde edilen AT- kalınlığı (T) ve AT- gerinim oranının (SR) mitral kapak kalsifikasyonlu (MAC) hastaları belirlemedeki önemini araştırmayı amaçladık.
Gereç ve Yöntem: Çalışmaya ekokardiyografi sonrası MAC tanısı alan 100 hasta (65 kadın, 35 erkek ve ortalama yaş 64.7 ± 12.1) ve kardiyovasküler risk faktörü benzer olan 50 kontrol (32 kadın, 18 erkek ve ortalama yaş 63.2 ± 12.8) alındı. Laboratuvar incelemeler ve AT US yapıldı. AT-T ve AT-SR hesaplandı.
Bulgular: MAC olan hastalarda AT-T ve AT-SR belirgin olarak yüksek olduğu bulundu. Logistic regresyon analizinde, AT-T ve AT-SR değerlerinin MAC olma riskini bağımsız olarak belirlediği bulundu. Bu analize göre AT-T (her 1 mm) ve AT-SR (her 0.1)’nin MAC olma riskini sırası ile %69.9 ve %12.7 oranlarında artırdığı saptandı. AT-T ve AT-SR değerlerinin MAC olan hastaları belirlemesi açısından ROC analizi yapıldığında, ROC eğri altında kalan alanın sırası ile 0.684 ve 0.819 belirlendi. Aynı analizde, AT-SR için sınır değer 1.25 olarak alındığında %94.1 sensitivite ve %76.2 spesivite ile MAC varlığını belirlediği tespit edildi.
Sonuç: AT SE incelemesinde saptanan AT-SR, MAC olan hastaları önceden belirlemede kullanılabilecek basit, ucuz, tekrarlanabilir ve non-invaziv bir parametredir. Bu durum MAC ve AT-SR artışının benzer fizyopatolojik mekanizma ile meydana gelebilmesinin bir sonucu olabilir.

Keywords

Aşil tendon gerinim oranı, Aşil tendon kalınlığı, gerinim elastografisi, mitral anulus kalsifikasyonu

References

• 1. Elgendy IY, Conti CR. Caseous calcification of the mitral annulus: a review. Clin Cardiol. 2013;36(10):27-31.
• 2. Allison MA, Cheung P, Criqui MH, Langer RD, Wright CM. Mitral and aortic annular calcification are highly associated with systemic calcified atherosclerosis. Circulation. 2006;113:861-6.
• 3. Kanjanauthai S, Nasir K, Katz R, Rivera JJ, Takasu J, Blumenthal RS et al. Relationships of mitral annular calcification to cardiovascular risk factors: the Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis. 2010;213:558-62.
• 4. Asselbergs FW, Mozaffarian D, Katz R, Kestenbaum B, Fried LF, Gottdiener JS et al. Association of renal function with cardiac calcifications in older adults: the cardiovascular health study. Nephrol Dial Transplant. 2009;24:834-40.
• 5. Foley PW, Hamaad A, El-Gendi H, Leyva F. Incidental cardiac findings on computed tomography imaging of the thorax. BMC Res Notes. 2010;3:326.
• 6. Abramowitz Y, Jilaihawi H, Chakravarty T, Mack MJ, Makkar RR. Mitral annulus calcification. J Am Coll Cardiol. 2015;66(17):1934-41.
• 7. D'Cruz I, Panetta F, Cohen H, Glick G. Submitral calcification or sclerosis in elderly patients: M mode and two-dimensional echocardiography in "mitral annulus calcification". Am J Cardiol. 1979;44:31-8.
• 8. Schweitzer ME, Karasick D. MR imaging of disorders of the Achilles tendon. AJR Am J Roentgenol. 2000;175:613-25.
• 9. Descamps OS, Leysen X, Van Leuven F, Heller FR. The use of Achilles tendon ultrasonography for the diagnosis of familial hypercholesterolemia. Atherosclerosis. 2001;157:514-8.
• 10. Michikura M, Ogura M, Yamamoto M, Sekimoto M, Fuke C, Hori M et al. Achilles tendon ultrasonography for diagnosis of familial hypercholesterolemia among Japanese subjects. Circ J. 2017;81:1879-85.
• 11. Harada-Shiba M, Arai H, Okamura T, Yokote K, Oikawa S, Nohara A et al. Multicenter study to determine the diagnosis criteria of heterozygous familial hypercholesterolemia in Japan. J Atheroscler Thromb. 2012;19:1019-26.
• 12. Garra BS. Elastography: current status, future prospects, and making it work for you. Ultrasound Q. 2011;27:177-86.
• 13. Turan A, Teber MA, Yakut ZI, Unlu HA, Hekimoglu B. Sonoelastographic assessment of the age-related changes of the Achilles tendon. Med Ultrason. 2015;17:58-61.
• 14. Wearing SC, Hooper SL, Grigg NL, Nolan G, Smeathers JE. Overweight and obesity alter the cumulative transverse strain in the Achilles tendon immediately following exercise. J Bodyw Mov Ther. 2013;17:316-21.
• 15. Ağladıoğlu K, Akkaya N, Güngör HR, Akkaya S, Ök N, Özçakar L. Effects of cigarette smoking on elastographic strain ratio measurements of patellar and Achilles tendons. J Ultrasound Med. 2016;35:2431-8.
• 16. Evranos B, Idilman I, Ipek A, Polat SB, Cakir B, Ersoy R. Real-time sonoelastography and ultrasound evaluation of the Achilles tendon in patients with diabetes with or without foot ulcers: a cross-sectional study. J Diabetes Complications. 2015;29:1124-9.
• 17. Jarauta E, Junyent M, Gilabert R, Plana N, Mateo-Gallego R, de Groot E et al. Sonographic evaluation of Achilles tendons and carotid atherosclerosis in familial hypercholesterolemia. Atherosclerosis. 2009;204:345-7.
• 18. Junyent M, Gilabert R, Zambón D, Núñez I, Vela M, Civeira F et al. The use of Achilles tendon sonography to distinguish familial hypercholesterolemia from other genetic dyslipidemias. Arterioscler Thromb Vasc Biol. 2005;25:2203-8.
• 19. Kiortsis DN, Argyropoulou MI, Xydis V, Tsouli SG, Elisaf MS. Correlation of Achilles tendon thickness evaluated by ultrasonography with carotid intima-media thickness in patients with familial hypercholesterolemia. Atherosclerosis. 2006;186:228-9.
• 20. Koc AS, Pekoz BC, Donmez Y, Yasar S, Ardic M, Gorgulu FF et al. Usability of Achilles tendon strain elastography for the diagnosis of coronary artery disease. J Med Ultrason. 2019;46(3):343-51.
• 21. Fox CS, Vasan RS, Parise H, Levy D, O'Donnell CJ, D'Agostino RB et al. Mitral annular calcification predicts cardiovascular morbidity and mortality: the Framingham Heart Study. Circulation. 2003;107:1492-6.
• 22. Roelandt J, Gibson DG. Recommendations for standardization of measurements from M-mode echocardiograms. Eur Heart J. 1980;1(5):375-8.
• 23. Kohsaka S, Jin Z, Rundek T, Boden-Albala B, Homma S, Sacco RL et al. Impact of mitral annular calcification on cardiovascular events in a multiethnic community: the Northern Manhattan Study. J Am Coll Cardiol Img. 2008;1:617-23.
• 24. Ying M, Yeung E, Li B, Li W, Lui M, Tsoi CW. Sonographic evaluation of the size of Achilles tendon: the effect of exercise and dominance of the ankle. Ultrasound Med Biol. 2003;29:637-42.
• 25. De Zordo T, Fink C, Feuchtner GM, Smekal V, Reindl M, Klauser AS. Real-time sonoelastography findings in healthy Achilles tendons. AJR Am J Roentgenol. 2009;193:134-8.
• 26. Frey H. Real-time elastography: a new ultrasound procedure for the reconstruction of tissue elasticity [in German]. Radiologe. 2003;43:850-5.
• 27. Tsouli SG, Kiortsis DN, Argyropoulou MI, Mikhailidis DP, Elisaf MS. Pathogenesis, detection and treatment of Achilles tendon xanthomas. Eur J Clin Invest. 2005;35:236-44.
• 28. Gounopoulos P, Merki E, Hansen LF, Choi SH, Tsimikas S. Antibodies to oxidized low density lipoprotein: epidemiological studies and potential clinical applications in cardiovascular disease. Minerva Cardioangiol. 2007;55(6):821-37.
• 29. Mori M, Itabe H, Higashi Y, Fujimoto Y, Shiomi M, Yoshizumi M et al. Foam cell formation containing lipid droplets enriched with free cholesterol by hyperlipidemic serum. J Lipid Res. 2001;42:1771-81.
• 30. Adler Y, Fink N, Spector D, Wiser I, Sagie A. Mitral annulus calcification- a window to diffuse atherosclerosis of the vascular system. Atherosclerosis. 2001;155:1-8.
• 31. Barasch E, Gottdiener JS, Larsen EK, Chaves PH, Newman AB, Manolio TA. Clinical significance of calcification of the fibrous skeleton of the heart and aortosclerosis in community-dwelling elderly. The Cardiovascular Health Study (CHS). Am Heart J. 2006;151:39-47.
• 32. Boon A, Cheriex E, Lodder J, Kessels F. Cardiac valve calcification: characteristics of patients with calcification of the mitral annulus or aortic valve. Heart. 1997;78:472-4.
• 33. LaCroix AS, Duenwald-Kuehl SE, Lakes RS, Vanderby R Jr. Relationship between tendon stiffness and failure: A meta-analysis. J Appl Physiol. 2013;115:43-51.
• 34. Couppé C, Hansen P, Kongsgaard M, Kovanen V, Suetta C, Aagaard P et al. Mechanical properties and collagen cross-linking of the patellar tendon in old and young men. J Appl Physiol. 2009;107:880-6.
• 35. Jassal DS, Tam JW, Bhagirath KM, Gaboury I, Sochowski RA, Dumesnil JG et al. Association of mitral annular calcification and aortic valve morphology: a substudy of the aortic stenosis progression observation measuring effects of rosuvastatin (ASTRONOMER) study. Eur Heart J. 2008;29(12):1542-7.
• 36. Klauser AS, Miyamoto H, Tamegger M, Faschingbauer R, Moriggl B, Klima G et al. Achilles tendon assessed with sonoelastography: histologic agreement. Radiology. 2013;267:837-42.
• 37. Ivanac G, Lemac D, Kosovic V, Bojanic K, Cengic T, Dumic-Cule I et al. Importance of shear-wave elastography in prediction of Achilles tendon rupture. Int Orthop. 2021;45(4):1043-7.