Disease Activity in Mitral Annular Calcification

Daniele Massera, Maria G. Trivieri, Jack P.M. Andrews, Samantha Sartori, Ronan Abgral, Andrew R. Chapman, William S.A. Jenkins, Alex T. Vesey, Mhairi K. Doris, Tania A. Pawade, Kang H. Zheng, Jorge Kizer, David E. Newby, Marc R. Dweck

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

BACKGROUND: Mitral annular calcification (MAC) is associated with cardiovascular events and mitral valve dysfunction. However, the underlying pathophysiology remains incompletely understood. In this prospective longitudinal study, we used a multimodality approach including positron emission tomography, computed tomography, and echocardiography to investigate the pathophysiology of MAC and assess factors associated with disease activity and progression. METHODS: A total of 104 patients (age 72±8 years, 30% women) with calcific aortic valve disease, therefore predisposed to MAC, underwent 18F-sodium fluoride (calcification activity) and 18F-Fluorodeoxyglucose (inflammation activity) positron emission tomography, computed tomography calcium scoring, and echocardiography. Sixty patients underwent repeat computed tomography and echocardiography after 2 years. RESULTS: MAC (mitral annular calcium score >0) was present in 35 (33.7%) patients who had increased 18F-fluoride (tissue-to-background ratio, 2.32 [95% CI, 1.81-3.27] versus 1.30 [1.22-1.49]; P<0.001) and 18F-Fluorodeoxyglucose activity (tissue-to-background ratio, 1.44 [1.37-1.58] versus 1.17 [1.12-1.24]; P<0.001) compared with patients without MAC. MAC activity (18F-fluoride uptake) was closely associated with the local calcium score and 18F-Fluorodeoxyglucose uptake, as well as female sex and renal function. Similarly, MAC progression was closely associated with local factors, in particular, baseline MAC. Traditional cardiovascular risk factors and calcification activity in bone or remote atherosclerotic areas were not associated with disease activity nor progression. CONCLUSIONS: MAC is characterized by increased local calcification activity and inflammation. Baseline MAC burden was associated with disease activity and the rate of subsequent progression. This suggests a self-perpetuating cycle of calcification and inflammation that may be the target of future therapeutic interventions.

Original languageEnglish (US)
Pages (from-to)e008513
JournalCirculation. Cardiovascular imaging
Volume12
Issue number2
DOIs
StatePublished - Feb 1 2019
Externally publishedYes

Fingerprint

Fluorodeoxyglucose F18
Echocardiography
Inflammation
Calcium
Fluorides
Sodium Fluoride
Aortic Diseases
Aortic Valve
Mitral Valve
Longitudinal Studies
Disease Progression
Tomography
Prospective Studies
Kidney
Bone and Bones
Positron Emission Tomography Computed Tomography
Therapeutics

Keywords

  • disease progression
  • inflammation
  • mitral valve
  • positron emission tomography computed tomography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Massera, D., Trivieri, M. G., Andrews, J. P. M., Sartori, S., Abgral, R., Chapman, A. R., ... Dweck, M. R. (2019). Disease Activity in Mitral Annular Calcification. Circulation. Cardiovascular imaging, 12(2), e008513. https://doi.org/10.1161/CIRCIMAGING.118.008513

Disease Activity in Mitral Annular Calcification. / Massera, Daniele; Trivieri, Maria G.; Andrews, Jack P.M.; Sartori, Samantha; Abgral, Ronan; Chapman, Andrew R.; Jenkins, William S.A.; Vesey, Alex T.; Doris, Mhairi K.; Pawade, Tania A.; Zheng, Kang H.; Kizer, Jorge; Newby, David E.; Dweck, Marc R.

In: Circulation. Cardiovascular imaging, Vol. 12, No. 2, 01.02.2019, p. e008513.

Research output: Contribution to journalArticle

Massera, D, Trivieri, MG, Andrews, JPM, Sartori, S, Abgral, R, Chapman, AR, Jenkins, WSA, Vesey, AT, Doris, MK, Pawade, TA, Zheng, KH, Kizer, J, Newby, DE & Dweck, MR 2019, 'Disease Activity in Mitral Annular Calcification', Circulation. Cardiovascular imaging, vol. 12, no. 2, pp. e008513. https://doi.org/10.1161/CIRCIMAGING.118.008513
Massera D, Trivieri MG, Andrews JPM, Sartori S, Abgral R, Chapman AR et al. Disease Activity in Mitral Annular Calcification. Circulation. Cardiovascular imaging. 2019 Feb 1;12(2):e008513. https://doi.org/10.1161/CIRCIMAGING.118.008513
Massera, Daniele ; Trivieri, Maria G. ; Andrews, Jack P.M. ; Sartori, Samantha ; Abgral, Ronan ; Chapman, Andrew R. ; Jenkins, William S.A. ; Vesey, Alex T. ; Doris, Mhairi K. ; Pawade, Tania A. ; Zheng, Kang H. ; Kizer, Jorge ; Newby, David E. ; Dweck, Marc R. / Disease Activity in Mitral Annular Calcification. In: Circulation. Cardiovascular imaging. 2019 ; Vol. 12, No. 2. pp. e008513.
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AU - Chapman, Andrew R.

AU - Jenkins, William S.A.

AU - Vesey, Alex T.

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AU - Pawade, Tania A.

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N2 - BACKGROUND: Mitral annular calcification (MAC) is associated with cardiovascular events and mitral valve dysfunction. However, the underlying pathophysiology remains incompletely understood. In this prospective longitudinal study, we used a multimodality approach including positron emission tomography, computed tomography, and echocardiography to investigate the pathophysiology of MAC and assess factors associated with disease activity and progression. METHODS: A total of 104 patients (age 72±8 years, 30% women) with calcific aortic valve disease, therefore predisposed to MAC, underwent 18F-sodium fluoride (calcification activity) and 18F-Fluorodeoxyglucose (inflammation activity) positron emission tomography, computed tomography calcium scoring, and echocardiography. Sixty patients underwent repeat computed tomography and echocardiography after 2 years. RESULTS: MAC (mitral annular calcium score >0) was present in 35 (33.7%) patients who had increased 18F-fluoride (tissue-to-background ratio, 2.32 [95% CI, 1.81-3.27] versus 1.30 [1.22-1.49]; P<0.001) and 18F-Fluorodeoxyglucose activity (tissue-to-background ratio, 1.44 [1.37-1.58] versus 1.17 [1.12-1.24]; P<0.001) compared with patients without MAC. MAC activity (18F-fluoride uptake) was closely associated with the local calcium score and 18F-Fluorodeoxyglucose uptake, as well as female sex and renal function. Similarly, MAC progression was closely associated with local factors, in particular, baseline MAC. Traditional cardiovascular risk factors and calcification activity in bone or remote atherosclerotic areas were not associated with disease activity nor progression. CONCLUSIONS: MAC is characterized by increased local calcification activity and inflammation. Baseline MAC burden was associated with disease activity and the rate of subsequent progression. This suggests a self-perpetuating cycle of calcification and inflammation that may be the target of future therapeutic interventions.

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