Evaluation of the Relationship Between Mitral Annular Calcification and CRP/albumin Ratio

Abstract

Aim: The relationship between mitral annular calcification (MAC) and atherosclerotic diseases is known. The CRP/albumin ratio (CAR) is one of the indicators of inflammation of the atherosclerotic process. We aim to examine the relationship between MAC and CAR values. Material and Method: The study included 197 patients with MAC and a control group of 200 retrospectively between January 2021 and December 2021. We analyzed the relationship between CAR and MAC according to the hospital records, including laboratory findings, echocardiography reports, and patient characteristics. Results: We found higher CAR values in patients with MAC compared to the control group (p<0.001). In addition, CAR was predictive for MAC determined by regression analysis (OR: 52.37, 95% CI: 7.37–372.06, p<0.001). Conclusion: CRP/albumin ratio values, essential indicators of inflammation, were higher in the patient population with MAC. This finding may reveal that inflammation is also effective in the pathogenesis of MAC.

Keywords

• CRP/albumin ratio
• inflammation
• valvular calcification

References

1. 1. Roberts WC, Perloff JK. Mitral valvular disease. A clinicopathologic survey of the conditions causing the mitral valve to function abnormally. Ann Intern Med. 1972;77(6):93975. doi:10.7326/0003-4819-77-6-939
2. 2. Carpentier AF, Pellerin M, Fuzellier JF, Relland JY. Extensive calcification of the mitral valve anulus: pathology and surgical management. J Thorac Cardiovasc Surg. 1996;111(4):718–30. doi:10.1016/s0022-5223(96)70332-x
3. 3. 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):1–8. doi:10.1016/s00219150(00)00737-1
4. 4. Roberts WC. The senile cardiac calcification syndrome. Am J Cardiol. 1986;58(6):572–4. doi:10.1016/00029149(86)90045-7
5. 5. Shekar C, Budoff M. Calcification of the heart: mechanisms and therapeutic avenues. Expert Rev Cardiovasc Ther. 2018;16(7):527–36. doi:10.1080/14779072.2018.1484282
6. 6. Afshar M, Luk K, Do R, et al. Association of TriglycerideRelated Genetic Variants With Mitral Annular Calcification. J Am Coll Cardiol. 2017;69(24):2941–8. doi:10.1016/j. jacc.2017.04.051
7. 7. Freeman RV, Otto CM. Spectrum of calcific aortic valve disease: pathogenesis, disease progression, and treatment strategies. Circulation. 2005;111(24):3316–26. doi:10.1161/ CIRCULATIONAHA.104.486738
8. 8. Rencuzogullari I, Karabağ Y, Çağdaş M, et al. Assessment of the relationship between preprocedural C-reactive protein/albumin ratio and stent restenosis in patients with ST-segment elevation myocardial infarction. Rev Port Cardiol. 2019;38(4):269–77. doi:10.1016/j.repc.2018.08.008

9. 9. Çağdaş M, Rencüzoğullari I, Karakoyun S, et al. Assessment of Relationship Between C-Reactive Protein to Albumin Ratio and Coronary Artery Disease Severity in Patients With Acute Coronary Syndrome. Angiology. 2019;70(4):361–8. doi:10.1177/0003319717743325
10. 10. Wang W, Ren D, Wang C-S, Li T, Yao H-C, Ma S-J. Prognostic efficacy of high-sensitivity C-reactive protein to albumin ratio in patients with acute coronary syndrome. Biomark Med. 2019;13(10):811–20. doi:10.2217/bmm-2018-0346
11. 11. Rezaeian P, Miller PE, Haberlen SA, et al. Extra-coronary calcification (aortic valve calcification, mitral annular calcification, aortic valve ring calcification and thoracic aortic calcification) in HIV seropositive and seronegative men: Multicenter AIDS Cohort Study. J Cardiovasc Comput Tomogr. 2016;10(3):229–36. doi:10.1016/j.jcct.2016.02.002
12. 12. Bortnick AE, Bartz TM, Ix JH, et al. Association of inflammatory, lipid and mineral markers with cardiac calcification in older adults. Heart. 2016;102(22):1826–34. doi:10.1136/heartjnl-2016–309404
13. 13. Fox CS, Guo C-Y, Larson MG, et al. Relations of inflammation and novel risk factors to valvular calcification. Am J Cardiol. 2006;97(10):1502–5. doi:10.1016/j.amjcard.2005.11.086
14. 14. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur Heart J. 2018;39(33):3021–104. doi:10.1093/eurheartj/ehy339
15. 15. Association AD. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2021. Diabetes Care. 2020;44(Supplement_1):S15–33. doi:10.2337/dc21-S002
16. 16. Nair CK, Thomson W, Ryschon K, Cook C, Hee TT, Sketch MH. Long-term follow-up of patients with echocardiographically detected mitral anular calcium and comparison with age- and sex-matched control subjects. Am J Cardiol. 1989;63(7):46570. doi:10.1016/0002-9149(89)90321-4
17. 17. Guler S, Varol E. The relation between echocardiographic epicardial fat thickness and mitral annular calcification. Afr Health Sci. 2019;19(1):1657–64. doi:10.4314/ahs.v19i1.41
18. 18. Thanassoulis G, Campbell CY, Owens DS, et al. Genetic associations with valvular calcification and aortic stenosis. N Engl J Med. 2013;368(6):503–12. doi:10.1056/NEJMoa1109034
19. 19. Thanassoulis G, Massaro JM, Cury R, et al. Associations of longterm and early adult atherosclerosis risk factors with aortic and mitral valve calcium. J Am Coll Cardiol. 2010;55(22):2491–8. doi:10.1016/j.jacc.2010.03.019
20. 20. Yayla Ç, Akboğa MK, Canpolat U, et al. [The relationship between mitral annular calcification and red cell distribution width: a cross-sectional study]. Turk Kardiyol Dern Ars. 2015;43(8):692–8. doi:10.5543/tkda.2015.23539
21. 21. Ardahanli I, Cengizhan MS, Celik M, Kader S, Akarslan M, Takir M. Carotid artery intima-media thickness and heart valve calcifications in hemodialysis patients with hyperparathyroidism (A Pilot Study). Arch Nephrol Urol. 2019;2(2):52–61.
22. 22. Karabağ Y, Çağdaş M, Rencuzogullari I, et al. Usefulness of T he C-Reactive Protein/Albumin Ratio for Predicting NoReflow in ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. Eur J Clin Invest. 2018;48(6):e12928. doi:10.1111/eci.12928
23. 23. Torzewski M, Rist C, Mortensen RF, et al. C-reactive protein in the arterial intima: role of C-reactive protein receptor-dependent monocyte recruitment in atherogenesis. Arterioscler Thromb Vasc Biol. 2000;20(9):2094–9. doi:10.1161/01.atv.20.9.2094
24. 24. Torzewski J, Torzewski M, Bowyer DE, et al. C-reactive protein frequently colocalizes with the terminal complement complex in the intima of early atherosclerotic lesions of human coronary arteries. Arterioscler Thromb Vasc Biol. 1998;18(9):1386–92. doi:10.1161/01.atv.18.9.1386
25. 25. Taskinen S, Kovanen PT, Jarva H, Meri S, Pentikäinen MO. Binding of C-reactive protein to modified low-density-lipoprotein particles: identification of cholesterol as a novel ligand for C-reactive protein. Biochem J. 2002;367(Pt 2):403–12. doi:10.1042/BJ20020492
26. 26. Pasceri V, Willerson JT, Yeh ET. Direct proinflammatory effect of C-reactive protein on human endothelial cells. Circulation. 2000;102(18):2165–8. doi:10.1161/01.cir.102.18.2165
27. 27. Mikhailidis DP, Ganotakis ES. Plasma albumin and platelet function: relevance to atherogenesis and thrombosis. Platelets. 1996;7(3):125–37. doi:10.3109/09537109609023571