Comparision of Cardiovascular Risk Factors and Carotis Intima Media Thickness in Patients with Single Valve and Double Valve Calcifications

Abstract

Aim: Although previous studies have shown a significant association between coronary risk factors or carotid atherosclerosis and valvular calcifications, there is conflicting evidence about which clinical cardiovascular risk factors are related to valvular calcifications.We aimed to evaluate the cardiovascular risk factors and carotid intima media thicknesses in patients with single and double valve calcifications in whom echocardiography has been performed prior to elective coronary angiography. Materials and Methods: 100 patients having double valve calcifications (aortic valve calcification and mitral annular calcification; 47 female and 53 male; mean age 68.1±8.7 years) and 90 patients having single valve calcification (aortic valve calcification; 29 female and 61 male; mean age 62.8±9.8 years) were enrolled into the study. All patients underwent transthoracic echocardiography, carotis ultrasonography and coronary angiography. Results: Age, female gender and hypertension were found to be significantly higher in patients with double valve calcifications (p=0.0001, 0.038 and 0.027; respectively). In means of hyperlipidemia, smoking, diabetes mellitus, body mass index, coronary artery disease and carotis intima media thickness, no significant difference was observed between the both groups. Age and female gender were found to be independent predictors in patients with double valve calcifications. Conclusion: These data have suggested that aortic and mitral valve calcifications may have different pathogenetic mechanisms and mitral annular calcification may also have some additional pathogenetic factors. Key words: Aortic Valve Calcification; Mitral Annular Calcification; Carotis Intima Media Thickness; Cardiovascular Risk Factors.

Keywords

• Aortic Valve Calcification; Mitral Annular Calcification; Carotis Intima Media Thickness; Cardiovascular Risk Factors.

Tek Kapak ve Çift Kapak Kalsifikasyonlu Hastalarda Kardiyovasküler Risk Faktörleri ve Karotis İntima Media Kalınlığının Karşılaştırılması

Öz

Amaç: Önceki çalışmalarda, kapak kalsifikasyonları ile koroner arter hastalığı veya karotid aterosklerotik hastalık arasındaki yakın ilişki gösterilmiş olmasına rağmen, hangi klinik kardiyovasküler risk faktörlerinin kapak kalsifikasyonları ile ilişkili olduğu hakkında çelişkiler mevcuttur. Bu çalışmada, elektif koroner anjiyografi öncesi ekokardiyografi yapılan tek kapak ve çift kapak kalsifikasyonlu hastalarda kardiyovasküler risk faktörlerini ve karotis intima media kalınlıklarını değerlendirmeyi amaçladık. Gereç ve Yöntem: Çalışmaya çift kapak kalsifikasyonu olan 100 hasta (aort kapak kalsifikasyonu ve mitral annüler kalsifikasyon; 47 kadın ve 53 erkek; ortalama yaş 68,1±8,7 yaş) ve tek kapak kalsifikasyonu olan 90 hasta (aort kapak kalsifikasyonu; 29 kadın ve 61 erkek; ortalama yaş 62,8±9,8 yaş) alındı. Tüm hastalara transtorasik ekokardiyografi, karotis ultrasonografi ve koroner anjiyografi yapıldı. Bulgular: Yaş, kadın cinsiyet ve hipertansiyon çift kapak kalsifikasyonu olan hastalarda anlamlı olarak daha yüksek bulundu (sırasıyla; p=0,0001, p=0,038 ve p=0,027). Her iki grup arasında hiperlipidemi, sigara içimi, diyabetes mellitus, vücut kitle indeksi, koroner arter hastalığı ve karotis intima media kalınlığı yönünden anlamlı farklılık bulunmadı. Çift kapak kalsifikasyonu olan hastalarda, yaş ve kadın cinsiyet bağımsız belirleyiciler olarak bulundu. Sonuç: Bu veriler, aort ve mitral kapak kalsifikasyonlarının farklı patojenik mekanizmaları olabileceğini ve mitral annüler kalsifikasyon gelişiminde ayrıca bazı ek faktörlerin rol oynayabileceğini düşündürmektedir. Anahtar kelimeler: Aort Kapak Kalsifikasyonu; Mitral Annüler Kalsifikasyon; Karotis İntima Media Kalınlığı; Kardiyovasküler Risk Faktörleri.

Anahtar Kelimeler

• Aort Kapak Kalsifikasyonu; Mitral Annüler Kalsifikasyon; Karotis İntima Media Kalınlığı; Kardiyovasküler Risk Faktörleri.

Kaynakça

1. Mohler ER, Gannon F, Reynolds C, et al. Bone formation and inflammation in cardiac valves. Circulation 2001; 103: 1522-8.
2. Hunt JL, Fairman R, Mitchell ME, et al. Bone formation in carotid plaques: a clinicopathological study. Stroke 2002; 33: 1214-9.
3. Kanjanauthai S, Nasir K, Katz R, et al. Relationships of mitral annular calcification to cardiovascular risk factors: the Multi- Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 2010; 213: 558-62.
4. Sgorbini L, Scuteri A, Leggio M, et al. Carotid intima-media thickness, carotid distensibility and mitral, aortic valve calcification: a useful diagnostic parameter of systemic atherosclerotic disease. J Cardiovasc Med 2007; 8: 342-7.
5. Jeon DS, Atar S, Brasch AV, et al. Association of mitral annulus calcification, aortic valve sclerosis and aortic root calcification with abnormal myocardial perfusion single photon emission tomography in subjects aged ≤65 years old. J Am Coll Cardiol 2001; 38: 1988-93.
6. Adler Y, Koren A, Fink N, et al. Association between mitral annulus calcification and carotid atherosclerotic disease. Stroke 1998; 29: 1833-7.
7. Adler Y, Fink N, Spector D, et al. Mitral annulus calcification-a window to diffuse atherosclerosis of the vascular system. Atherosclerosis 2001; 155:1-8.
8. Adler Y, Herz I, Vaturi M, , et al. Mitral annulus calcium detected by transthoracic echocardiography is a marker for high prevalence and severity of coronary artery disease in patients undergoing coronary angiography. Am J Cardiol 1998; 82: 1183- 6.

9. Otto CM, Lind BK, Kitzman DW, et al. Association of aortic valve sclerosis with cardiovascular mortality and morbidity in the elderly. N Engl J Med 1999; 341:142-7.
10. Stewart BF, Siscovick D, Lind BK, et al. Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study. J Am Coll Cardiol 1997; 29: 630-4.
11. Boon A, Cheriex E, Lodder J, et al. Cardiac valve calcification: characteristics of patients with calcification of the mitral annulus or aortic valve. Heart 1997; 78: 472-4.
12. Savage DD, Garrison RJ, Castelli WP, et al. Prevalence of submitral (annular) calcium and its correlates in a general population-based sample (The Framingham Study). Am J Cardiol 1983; 51: 1375-8.
13. Kim HK, Park SJ, Suh JW, et al. Association between cardiac valvular calcification and coronary artery disease in a low-risk population. Coron Artery Dis 2004; 15: 1-6.
14. Atar S, Jeon DS, Luo H, Siegel RJ. Mitral annular calcification: A marker of severe coronary artery disease in patients under 65 years old. Heart 2003; 89: 161-4.
15. Sgorbini L, Scuteri A, Leggio M et al. Association of mitral annulus calcification, aortic valve calcification with carotid intima media thickness. Cardiovascular Ultrasound 2004; 2: 19.
16. Allison MA, Cheung P, Criqui MH, et al. Mitral and aortic annular calcification are highly associated with systemic calcified atherosclerosis. Circulation 2006; 14;113: 861-6.
17. Messika-Zeitoun D, Bielak LF, Peyser PA, et al. Aortic valve calcification: Determinants and progression in the population. Arterioscler Thromb Vasc Biol 2007; 27: 642-8.
18. Tohno S, Tohno Y, Minami T, et al. Accumulation of calcium and phosphorus in the mitral valve in comparison with the abdominal aorta and the scaphoid bone. Biol Trace Elem Res 2000; 77: 33-42.
19. Tohno Y, Tohno S, Mahakkanukrauh P, et al. Earlier accumulation of calcium, phosphorus, and magnesium in the coronary artery in comparison with the ascending aorta, aortic valve, and mitral valve. Biol Trace Elem Res 2006; 112: 31-42.