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Morariu PC, Oancea AF, Gosav EM, Buliga-Finis ON, Cuciureanu M, Scripcariu DV, Sirbu O, Godun MM, Floria DE, Chiriac PC, Baroi LG, Ouatu A, Tanase DM, Rezus C, Floria M. Rethinking Mitral Annular Calcification and Its Clinical Significance: From Passive Process to Active Pathology. J Pers Med 2024; 14:900. [PMID: 39338154 PMCID: PMC11433102 DOI: 10.3390/jpm14090900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 08/20/2024] [Accepted: 08/24/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Mitral annulus calcification is a chronic degenerative condition affecting the fibrous base of the mitral valve. Historically viewed as an age-related phenomenon, recent studies suggest it is driven by active mechanisms involving systemic inflammation, hemodynamic stress, abnormal calcium-phosphorus metabolism, and lipid accumulation. Despite often being asymptomatic and incidentally detected, its clinical relevance stems from its strong association with increased cardiovascular disease risk, higher cardiovascular mortality, and elevated overall mortality. METHODS This article investigates the complexities and controversies surrounding mitral annular calcification as a potential embolic source, focusing on its diagnosis, its relationship with systemic inflammation, and its links to metabolic and chronic disorders. RESULTS The findings highlight that mitral annular calcification is not merely a passive marker of aging but an active indicator of atherosclerotic burden with significant implications for cardiovascular health. CONCLUSION Mitral annulus calcification should be recognized as an important factor in cardiovascular risk assessment, offering insight into systemic inflammatory processes and metabolic dysregulation.
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Affiliation(s)
- Paula Cristina Morariu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (P.C.M.); (E.M.G.); (O.N.B.-F.); (O.S.); (M.M.G.); (D.-E.F.); (A.O.); (D.M.T.); (C.R.); (M.F.)
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital Iasi, 700111 Iasi, Romania;
| | - Alexandru Florinel Oancea
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (P.C.M.); (E.M.G.); (O.N.B.-F.); (O.S.); (M.M.G.); (D.-E.F.); (A.O.); (D.M.T.); (C.R.); (M.F.)
- Cardiology Clinic, “Sf. Spiridon” Emergency Hospital Iasi, 700111 Iasi, Romania
| | - Evelina Maria Gosav
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (P.C.M.); (E.M.G.); (O.N.B.-F.); (O.S.); (M.M.G.); (D.-E.F.); (A.O.); (D.M.T.); (C.R.); (M.F.)
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital Iasi, 700111 Iasi, Romania;
| | - Oana Nicoleta Buliga-Finis
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (P.C.M.); (E.M.G.); (O.N.B.-F.); (O.S.); (M.M.G.); (D.-E.F.); (A.O.); (D.M.T.); (C.R.); (M.F.)
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital Iasi, 700111 Iasi, Romania;
| | - Magdalena Cuciureanu
- Department of Pharmacology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | | | - Oana Sirbu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (P.C.M.); (E.M.G.); (O.N.B.-F.); (O.S.); (M.M.G.); (D.-E.F.); (A.O.); (D.M.T.); (C.R.); (M.F.)
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital Iasi, 700111 Iasi, Romania;
| | - Maria Mihaela Godun
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (P.C.M.); (E.M.G.); (O.N.B.-F.); (O.S.); (M.M.G.); (D.-E.F.); (A.O.); (D.M.T.); (C.R.); (M.F.)
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital Iasi, 700111 Iasi, Romania;
| | - Diana-Elena Floria
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (P.C.M.); (E.M.G.); (O.N.B.-F.); (O.S.); (M.M.G.); (D.-E.F.); (A.O.); (D.M.T.); (C.R.); (M.F.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iasi, Romania
| | | | - Livia Genoveva Baroi
- Department of General Surgery, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Anca Ouatu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (P.C.M.); (E.M.G.); (O.N.B.-F.); (O.S.); (M.M.G.); (D.-E.F.); (A.O.); (D.M.T.); (C.R.); (M.F.)
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital Iasi, 700111 Iasi, Romania;
| | - Daniela Maria Tanase
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (P.C.M.); (E.M.G.); (O.N.B.-F.); (O.S.); (M.M.G.); (D.-E.F.); (A.O.); (D.M.T.); (C.R.); (M.F.)
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital Iasi, 700111 Iasi, Romania;
| | - Ciprian Rezus
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (P.C.M.); (E.M.G.); (O.N.B.-F.); (O.S.); (M.M.G.); (D.-E.F.); (A.O.); (D.M.T.); (C.R.); (M.F.)
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital Iasi, 700111 Iasi, Romania;
| | - Mariana Floria
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (P.C.M.); (E.M.G.); (O.N.B.-F.); (O.S.); (M.M.G.); (D.-E.F.); (A.O.); (D.M.T.); (C.R.); (M.F.)
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital Iasi, 700111 Iasi, Romania;
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Wang M, Zhang H, Liu Z, Han J, Liu J, Zhang N, Li S, Tang W, Liu P, Tian B, Luo T, Wang J, Meng X, Ye H, Xu L, Zhang H, Jiang W. Scoring model based on cardiac CT and clinical factors to predict early good mitral valve repair in rheumatic mitral disease. Eur Radiol 2024; 34:4963-4976. [PMID: 38252276 DOI: 10.1007/s00330-023-10470-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 09/24/2023] [Accepted: 10/16/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVE We aimed to evaluate the mitral valve calcification and mitral structure detected by cardiac computed tomography (cardiac CT) and establish a scoring model based on cardiac CT and clinical factors to predict early good mitral valve repair (EGMR) and guide surgical strategy in rheumatic mitral disease (RMD). MATERIALS AND METHODS This is a retrospective bi-center cohort study. Based on cardiac CT, mitral valve calcification and mitral structure in RMD were quantified and evaluated. The primary outcome was EGMR. A logical regression algorithm was applied to the scoring model. RESULTS A total of 579 patients were enrolled in our study from January 1, 2019, to August 31, 2022. Of these, 443 had baseline cardiac CT scans of adequate quality. The calcification quality score, calcification and thinnest part of the anterior leaflet clean zone, and papillary muscle symmetry were the independent CT factors of EGMR. Coronary artery disease and pulmonary artery pressure were the independent clinical factors of EGMR. Based on the above six factors, a scoring model was established. Sensitivity = 95% and specificity = 95% were presented with a cutoff value of 0.85 and 0.30 respectively. The area under the receiver operating characteristic of external validation set was 0.84 (95% confidence interval [CI] 0.73-0.93). CONCLUSIONS Mitral valve repair is recommended when the scoring model value > 0.85 and mitral valve replacement is prior when the scoring model value < 0.30. This model could assist in guiding surgical strategies for RMD. CLINICAL RELEVANCE STATEMENT The model established in this study can serve as a reference indicator for surgical repair in rheumatic mitral valve disease. KEY POINTS • Cardiac CT can reflect the mitral structure in detail, especially for valve calcification. • A model based on cardiac CT and clinical factors for predicting early good mitral valve repair was established. • The developed model can help cardiac surgeons formulate appropriate surgical strategies.
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Affiliation(s)
- Maozhou Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China
| | - Hongkai Zhang
- Department of Radiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Vascular Diseases, Capital Medical University, Beijing, China
| | - Zhou Liu
- Center for Clinical and Epidemiologic Research, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jie Han
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China
| | - Jing Liu
- Center for Clinical and Epidemiologic Research, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Nan Zhang
- Department of Radiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Vascular Diseases, Capital Medical University, Beijing, China
| | - Shuang Li
- Department of Radiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Vascular Diseases, Capital Medical University, Beijing, China
| | - Wenjie Tang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China
| | - Peiyi Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China
| | - Baiyu Tian
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China
| | - Tiange Luo
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China
| | - Jiangang Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China
| | - Xu Meng
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China
| | - Hongyu Ye
- Department of Cardiothoracic Surgery, Zhongshan City People's Hospital, Sun Wenzhong Road, Zhongshan, China.
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Vascular Diseases, Capital Medical University, Beijing, China.
| | - Hongjia Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China.
| | - Wenjian Jiang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China.
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Opris CE, Suciu H, Opris CI, Gurzu S. An Update on Mitral Valve Aging. Life (Basel) 2024; 14:950. [PMID: 39202692 PMCID: PMC11355775 DOI: 10.3390/life14080950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/21/2024] [Accepted: 07/26/2024] [Indexed: 09/03/2024] Open
Abstract
The aging process can have notable effects on the mitral valve. During life, the mitral valve undergoes various changes that can impact its structure and function. The purpose of this review is to present a comprehensive overview of the literature published up to February 2024 in the Medline database regarding the impact of aging on the mitral valve. The studies were combined with the personal experience of the authors. Until 2024, out of the 12,189 publications that deal with the mitral valve in elderly individuals, 308 refer to mitral valve aging. After reviewing these data, we selected and analyzed the 73 most informative works regarding the age-related transformation of the mitral valve. Understanding the mechanisms driving the aging of the mitral valve is crucial for enhancing diagnostic and therapeutic strategies for reducing age-related valve dysfunction and the subsequent cardiovascular complications.
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Affiliation(s)
- Carmen Elena Opris
- Department of Adult and Children Cardiovascular Recovery, Emergency Institute for Cardio-Vascular Diseases and Transplantation, 540139 Targu Mures, Romania;
- Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540139 Targu Mures, Romania
| | - Horatiu Suciu
- Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540139 Targu Mures, Romania; (H.S.); (C.I.O.)
- Romanian Academy of Medical Sciences, 030173 Bucharest, Romania
- Department of Cardiovascular Surgery, Emergency University Hospital, 050098 Bucharest, Romania
| | - Cosmin Ioan Opris
- Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540139 Targu Mures, Romania; (H.S.); (C.I.O.)
| | - Simona Gurzu
- Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540139 Targu Mures, Romania
- Romanian Academy of Medical Sciences, 030173 Bucharest, Romania
- Research Center for Oncopathology and Translational Medicine (CCOMT), George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540139 Targu Mures, Romania
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Gać P, Jaworski A, Grajnert F, Kicman K, Trejtowicz-Sutor A, Witkowski K, Poręba M, Poręba R. Aortic Valve Calcium Score: Applications in Clinical Practice and Scientific Research-A Narrative Review. J Clin Med 2024; 13:4064. [PMID: 39064103 PMCID: PMC11277735 DOI: 10.3390/jcm13144064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 06/29/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
In this narrative review, we investigate the essential role played by the computed tomography Aortic Valve Calcium Score (AVCS) in the cardiovascular diagnostic landscape, with a special focus on its implications for clinical practice and scientific research. Calcific aortic valve stenosis is the most prevalent type of aortic stenosis (AS) in industrialized countries, and due to the aging population, its prevalence is increasing. While transthoracic echocardiography (TTE) remains the gold standard, AVCS stands out as an essential complementary tool in evaluating patients with AS. The advantage of AVCS is its independence from flow; this allows for a more precise evaluation of patients with discordant findings in TTE. Further clinical applications of AVCS include in the assessment of patients before transcatheter aortic valve replacement (TAVR), as it helps in predicting outcomes and provides prognostic information post-TAVR. Additionally, we describe different AVCS thresholds regarding gender and the anatomical variations of the aortic valve. Finally, we discuss various scientific studies where AVCS was applied. As AVCS has some limitations, due to the pathophysiologies of AS extending beyond calcification and gender differences, scientists strive to validate contrast-enhanced AVCS. Furthermore, research on developing radiation-free methods of measuring calcium content is ongoing.
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Affiliation(s)
- Paweł Gać
- Centre of Diagnostic Imaging, 4th Military Hospital, Rudolfa Weigla 5, 50-981 Wrocław, Poland; (P.G.); (A.T.-S.); (K.W.)
- Department of Population Health, Division of Environmental Health and Occupational Medicine, Wroclaw Medical University, J. Mikulicza-Radeckiego 7, 50-345 Wrocław, Poland
| | - Arkadiusz Jaworski
- Healthcare Team “County Hospital” in Sochaczew, Batalionow Chlopskich 3/7, 96-500 Sochaczew, Poland
| | - Filip Grajnert
- 4th Military Hospital, Rudolfa Weigla 5, 50-981 Wrocław, Poland;
| | - Katarzyna Kicman
- Healthcare Team “County Hospital” in Sochaczew, Batalionow Chlopskich 3/7, 96-500 Sochaczew, Poland
| | - Agnieszka Trejtowicz-Sutor
- Centre of Diagnostic Imaging, 4th Military Hospital, Rudolfa Weigla 5, 50-981 Wrocław, Poland; (P.G.); (A.T.-S.); (K.W.)
| | - Konrad Witkowski
- Centre of Diagnostic Imaging, 4th Military Hospital, Rudolfa Weigla 5, 50-981 Wrocław, Poland; (P.G.); (A.T.-S.); (K.W.)
| | - Małgorzata Poręba
- Department of Paralympic Sports, Wroclaw University of Health and Sport Sciences, Witelona 25a, 51-617 Wrocław, Poland
| | - Rafał Poręba
- Department of Internal and Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland;
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Kietrsunthorn PS, Ghrair F, Schelegle AR, Foerst JR. Transcatheter Mitral Valve Therapies in Patients with Mitral Annular Calcification. Interv Cardiol Clin 2024; 13:237-248. [PMID: 38432766 DOI: 10.1016/j.iccl.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Mitral annular calcification is a chronic process involving degeneration and calcium deposition within the fibrous skeleton of the mitral valve annulus, which can lead to mitral valve dysfunction. It can be asymptomatic, or it can have pathologic sequelae leading to cardiovascular morbidity and mortality. Mitral annular calcification is increasingly recognized with the advancement of diagnostic imaging modalities, especially in an era with a growing elderly population. Its presence poses considerable challenges in terms of surgical and transcatheter management. Multiple surgical and transcatheter techniques have been developed to overcome these challenges. New transcatheter technologies are under investigation to tackle this problem.
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Affiliation(s)
- Patrick S Kietrsunthorn
- Structural and Interventional Cardiology, Virginia Tech Carilion School of Medicine and Carilion Clinic, 2001 Crystal Spring Road, Suite 203, Roanoke, VA 24014, USA
| | - Fadi Ghrair
- Structural and Interventional Cardiology, Virginia Tech Carilion School of Medicine and Carilion Clinic, 2001 Crystal Spring Road, Suite 203, Roanoke, VA 24014, USA
| | - Aaron R Schelegle
- Structural and Interventional Cardiology, Virginia Tech Carilion School of Medicine and Carilion Clinic, 2001 Crystal Spring Road, Suite 203, Roanoke, VA 24014, USA
| | - Jason R Foerst
- Structural and Interventional Cardiology, Virginia Tech Carilion School of Medicine and Carilion Clinic, 2001 Crystal Spring Road, Suite 203, Roanoke, VA 24014, USA.
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Kakavand M, Stembal F, Chen L, Mahboubi R, Layoun H, Harb SC, Xiang F, Elgharably H, Soltesz EG, Bakaeen FG, Hodges K, Vargo PR, Rajeswaran J, Firth A, Blackstone EH, Gillinov M, Roselli EE, Svensson LG, Pettersson GB, Unai S, Koprivanac M, Johnston DR. Contemporary experience with the Commando procedure for anterior mitral anular calcification. JTCVS OPEN 2024; 18:12-30. [PMID: 38690415 PMCID: PMC11056448 DOI: 10.1016/j.xjon.2023.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/22/2023] [Accepted: 10/10/2023] [Indexed: 05/02/2024]
Abstract
Objective Anterior mitral anular calcification, particularly in radiation heart disease, and previous valve replacement with destroyed intervalvular fibrosa are challenging for prosthesis sizing and placement. The Commando procedure with intervalvular fibrosa reconstruction permits double-valve replacement in these challenging conditions. We referenced outcomes after Commando procedures to standard double-valve replacements. Methods From January 2011 to January 2022, 129 Commando procedures and 1191 aortic and mitral double-valve replacements were performed at the Cleveland Clinic, excluding endocarditis. Reasons for the Commando were severe calcification after radiation (n = 67), without radiation (n = 43), and others (n = 19). Commando procedures were referenced to a subset of double-valve replacements using balancing-score methods (109 pairs). Results Between balanced groups, Commando versus double-valve replacement had higher total calcium scores (median 6140 vs 2680 HU, P = .03). Hospital outcomes were similar, including operative mortality (12/11% vs 8/7.3%, P = .35) and reoperation for bleeding (9/8.3% vs 5/4.6%, P = .28). Survival and freedom from reoperation at 5 years were 54% versus 67% (P = .33) and 87% versus 100% (P = .04), respectively. Higher calcium score was associated with lower survival after double-valve replacement but not after the Commando. The Commando procedure had lower aortic valve mean gradients at 4 years (9.4 vs 11 mm Hg, P = .04). After Commando procedures for calcification, 5-year survival was 60% and 59% with and without radiation, respectively (P = .47). Conclusions The Commando procedure with reconstruction of the intervalvular fibrosa destroyed by mitral anular calcification, radiation, or previous surgery demonstrates acceptable outcomes similar to standard double-valve replacement. More experience and long-term outcomes are required to refine patient selection for and application of the Commando approach.
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Affiliation(s)
- Mona Kakavand
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Filip Stembal
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lin Chen
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Rashed Mahboubi
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Habib Layoun
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Serge C. Harb
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Fei Xiang
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Haytham Elgharably
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Edward G. Soltesz
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Faisal G. Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kevin Hodges
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Patrick R. Vargo
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jeevanantham Rajeswaran
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Austin Firth
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eugene H. Blackstone
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eric E. Roselli
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lars G. Svensson
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gösta B. Pettersson
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Marijan Koprivanac
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Douglas R. Johnston
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
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Museedi AS, Le Jemtel TH. Mitral Annular Calcification-Related Valvular Disease: A Challenging Entity. J Clin Med 2024; 13:896. [PMID: 38337590 PMCID: PMC10856114 DOI: 10.3390/jcm13030896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
Mitral valve annular calcification-related valvular disease is increasingly common due to the rising prevalence of age-related mitral annular calcifications. Mitral annular calcification alters the structure and function of the mitral valve annulus, which in turn causes mitral valve regurgitation, stenosis, or both. As it frequently coexists with comorbid conditions and overlapping symptoms, mitral annular calcification-related valvular disease poses significant diagnostic and therapeutic challenges. For instance, left ventricular diastolic dysfunction hinders the assessment of mitral valvular disease. Detection of mitral annular calcifications and assessment of related mitral valve disease hinge on two-dimensional echocardiography. Comprehensive assessment of mitral annular calcifications and related mitral valve disease may require multidetector computed tomography and three-dimensional echocardiography. Invasive hemodynamic testing with exercise helps identify the cause of symptoms in patients with comorbid conditions, and transcatheter interventions have emerged as a viable therapeutic option for older patients. After an outline of the normal mitral annulus, we examine how mitral annular calcifications lead to mitral valve disease and how to accurately assess mitral regurgitation and stenosis. Lastly, we review surgical and transcatheter approaches to the management of mitral annular calcification-related mitral valve regurgitation, stenosis, or both.
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Affiliation(s)
| | - Thierry H. Le Jemtel
- Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, Tulane University Heart and Vascular Institute, New Orleans, LA 70112, USA;
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Hou J, Sun Y, Wang H, Zhang L, Shi J, You H, Zhang R, Yang B. Noncontrast cardiac computed tomography-derived mitral annular calcification scores in mitral valve disease. Clin Cardiol 2023; 46:1310-1318. [PMID: 37501607 PMCID: PMC10642324 DOI: 10.1002/clc.24110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND AND AIMS Mitral annular calcification (MAC) by computed tomography (CT) is reported as an independent predictor of poor outcomes. However, it currently remains unclear if quantitative MAC parameters provide more value for mitral valve disease (MVD) management, therefore, we examined the prognostic value of MAC scores using noncontrast cardiac-CT in MVD patients. METHODS Between January 2020 and December 2021, we prospectively enrolled 300 consecutive patients with MVD (MAC-present = 80 and MAC-absent = 220) undergoing preoperative cardiac-CT and mitral valve (MV) surgery. Noncontrast cardiac-CT images were used to qualitatively detect MAC (present or absent) and evaluate MAC scores. For analyses, we also collected baseline clinical data, intraoperative conversion (from MV repair to MV replacement), and follow-up arrhythmia data. RESULTS Compared with the MAC-absent group, MAC-present patients were older (62 ± 7 vs. 58 ± 9 years, p < .001), mostly women (55% vs. 39.5%, p = .017), and also had aortic valve calcification (57.5% vs. 23.2%, p < .001), mitral stenosis (82.5% vs. 61.8%, p < .001), atrial fibrillation (30% vs. 11.8%, p < .001), and larger left atrial end-diastolic dimension (LADD, 49 [44-56] versus 46 [41-50], p = .001]. Furthermore, MAC-present patients underwent more MV replacements (61.8% vs. 82.5%, p = .001) and experienced a higher intraoperative conversion prevalence (11.8% vs. 61.3%, p < .001). Multiple logistic regression analyses showed that the female gender (odds ratio [OR]/95% confidence interval [CI]/p = 2.001/1.042-3.841/0.037) and MAC scores (OR/95% CI/p = 10.153/4.434-23.253/p < .001) were independent predictors of intraoperative conversion. During a follow-up of 263 ± 134 days, MAC-present patients had more arrhythmias (42.5% vs. 9.5%, p < .001). Also, MAC-scores (hazard ratio [HR]/95% CI/p = 6.841/3.322-14.089/p < .001) and LADD (HR/95% CI/p = 1.039/1.018-1.060/p < .001) were independently associated with arrhythmias by Cox regression analyses. CONCLUSIONS Noncontrast cardiac CT-derived MAC-scores showed a high risk for intraoperative conversion and follow-up arrhythmias in MVD-patients.
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Affiliation(s)
- Jie Hou
- College of Medicine and Biological Information EngineeringNortheastern UniversityShenyangLiaoningChina
- Department of RadiologyGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
- Key Laboratory of Cardiovascular Imaging and Research of Liaoning ProvinceShenyangLiaoningChina
| | - Yu Sun
- College of Medicine and Biological Information EngineeringNortheastern UniversityShenyangLiaoningChina
- Department of RadiologyGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
- Key Laboratory of Cardiovascular Imaging and Research of Liaoning ProvinceShenyangLiaoningChina
| | - Huishan Wang
- Department of Cardiovascular SurgeryGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
| | - Libo Zhang
- Department of RadiologyGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
- Key Laboratory of Cardiovascular Imaging and Research of Liaoning ProvinceShenyangLiaoningChina
| | - Jinglong Shi
- Department of RadiologyGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
- Key Laboratory of Cardiovascular Imaging and Research of Liaoning ProvinceShenyangLiaoningChina
| | - Hongrui You
- Department of RadiologyGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
- Key Laboratory of Cardiovascular Imaging and Research of Liaoning ProvinceShenyangLiaoningChina
| | - Rongrong Zhang
- Department of RadiologyGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
- Key Laboratory of Cardiovascular Imaging and Research of Liaoning ProvinceShenyangLiaoningChina
| | - Benqiang Yang
- Department of RadiologyGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
- Key Laboratory of Cardiovascular Imaging and Research of Liaoning ProvinceShenyangLiaoningChina
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9
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Pampori A, Shekhar S, Kapadia SR. Implications of Renal Disease in Patients Undergoing Structural Interventions. Interv Cardiol Clin 2023; 12:539-554. [PMID: 37673498 DOI: 10.1016/j.iccl.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Percutaneous structural interventions have a major impact on the morbidity, mortality, and quality of life of patients by providing a lower-risk alternative to cardiac surgery. However, renal disease has a significant impact on outcomes of these interventions. This review explores the incidence, outcomes, pathophysiology, and preventative measures of acute kidney injury and chronic kidney disease on transcatheter aortic valve replacement, transcatheter mitral valve repair, and percutaneous balloon mitral valvuloplasty. Given the expanding indications for percutaneous structural interventions, further research is needed to identify ideal patients with chronic kidney disease or end-stage renal disease who would benefit from intervention.
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Affiliation(s)
- Adam Pampori
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Shashank Shekhar
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA.
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10
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Guerrero ME, Grayburn P, Smith RL, Sorajja P, Wang DD, Ahmad Y, Blusztein D, Cavalcante J, Tang GHL, Ailawadi G, Lim DS, Blanke P, Eleid MF, Kaneko T, Thourani VH, Bapat V, Mack MJ, Leon MB, George I. Diagnosis, Classification, and Management Strategies for Mitral Annular Calcification: A Heart Valve Collaboratory Position Statement. JACC Cardiovasc Interv 2023; 16:2195-2210. [PMID: 37758378 DOI: 10.1016/j.jcin.2023.06.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 10/02/2023]
Abstract
Mitral annular calcium (MAC) with severe mitral valvular dysfunction presents a complex problem, as valve replacement, either surgical or transcatheter, is challenging because of anatomy, technical considerations, concomitant comorbidities, and advanced age. The authors review the clinical and anatomical features of MAC that are favorable (green light), challenging (yellow light), or prohibitive (red light) for surgical or transcatheter mitral valve interventions. Under the auspices of the Heart Valve Collaboratory, an expert working group of cardiac surgeons, interventional cardiologists, and interventional imaging cardiologists was formed to develop recommendations regarding treatment options for patients with MAC as well as a proposed grading and staging system using both anatomical and clinical features.
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Affiliation(s)
| | | | | | - Paul Sorajja
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | - Yousif Ahmad
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - David Blusztein
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - João Cavalcante
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | | | - D Scott Lim
- University of Virginia, Charlottesville, Virginia, USA
| | - Philipp Blanke
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Tsuyoshi Kaneko
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Vinayak Bapat
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | - Martin B Leon
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Isaac George
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
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11
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Onuegbu A, Calicchio F, Kinninger A, Nakanishi R, Carr JJ, Nasir K, Gottesman R, Budoff M. Mitral annular calcification as a predictor of stroke in the multiethnic study of atherosclerosis. J Cardiovasc Med (Hagerstown) 2023; 24:680-688. [PMID: 37409651 DOI: 10.2459/jcm.0000000000001524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
BACKGROUND Mitral annular calcification (MAC) is associated with an increased risk for cardiovascular morbidity and mortality. This study provides recent data on the association between cardiac computed tomography (CT) derived MAC and 15 years of stroke risk in a racially diverse cohort. METHODS All multiethnic studies of atherosclerosis participants ( n = 6814) who completed a cardiac CT at baseline were included in this analysis. MAC score was calculated from cardiac CT using the Agatston and volume score methods. Multivariable Cox proportional hazard regression models were used to compute hazard ratios for the association between MAC and stroke after adjusting for traditional cardiovascular risk factors, inflammatory markers, coronary artery calcium score, atrial fibrillation, and left atrial size. RESULTS Overall, 9% of participants (644/6814) had MAC at baseline. Over a surveillance period of 15 years, 304 strokes occurred, and 79% were ischemic strokes. After adjusting for age, sex, race/ethnicity, SBP, diabetes, smoking, fibrinogen, IL-6, high-sensitivity C-reactive protein, and coronary artery calcium score, baseline MAC was associated with increased risk for all strokes [hazard ratio 1.68; 95% confidence interval (CI) 1.22-2.30: P = 0.0013]. When atrial fibrillation/flutter and left atrial size were included in the final multivariable model, MAC remained a predictor of all strokes (hazard ratio 1.93; 95% CI 1.22-3.05: P < 0.0051) and ischemic stroke (hazard ratio 2.03; 95% CI 1.24-3.31: P < 0.0046). CONCLUSION MAC is an independent predictor of long-term stroke risk in a racially diverse population beyond conventional cardiovascular risk factors and atrial fibrillation.
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Affiliation(s)
- Afiachukwu Onuegbu
- Division of Cardiology, Lundquist Institute at Harbor UCLA Medical Center, Torrance, California, USA
| | - Francesca Calicchio
- Division of Cardiology, Lundquist Institute at Harbor UCLA Medical Center, Torrance, California, USA
| | - April Kinninger
- Division of Cardiology, Lundquist Institute at Harbor UCLA Medical Center, Torrance, California, USA
| | - Rine Nakanishi
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - John J Carr
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Rebecca Gottesman
- Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Matthew Budoff
- Division of Cardiology, Lundquist Institute at Harbor UCLA Medical Center, Torrance, California, USA
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12
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Kwiecinski J, Kolossváry M, Tzolos E, Meah MN, Adamson PD, Joshi NV, Williams MC, van Beek EJR, Berman DS, Maurovich-Horvat P, Newby DE, Dweck MR, Dey D, Slomka PJ. Latent Coronary Plaque Morphology From Computed Tomography Angiography, Molecular Disease Activity on Positron Emission Tomography, and Clinical Outcomes. Arterioscler Thromb Vasc Biol 2023; 43:e279-e290. [PMID: 37165878 PMCID: PMC11006237 DOI: 10.1161/atvbaha.123.319332] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/27/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Assessments of coronary disease activity with 18F-sodium fluoride positron emission tomography and radiomics-based precision coronary plaque phenotyping derived from coronary computed tomography angiography may enhance risk stratification in patients with coronary artery disease. We sought to investigate whether the prognostic information provided by these 2 approaches is complementary in the prediction of myocardial infarction. METHODS Patients with known coronary artery disease underwent coronary 18F-sodium fluoride positron emission tomography and coronary computed tomography angiography on a hybrid positron emission tomography/computed tomography scanner. Coronary 18F-NaF uptake was determined by the coronary microcalcification activity. We performed quantitative plaque analysis of coronary computed tomography angiography datasets and extracted 1103 radiomic features for each plaque. Using weighted correlation network analysis, we derived latent morphological features of coronary lesions which were aggregated to patient-level radiomics nomograms to predict myocardial infarction. RESULTS Among 260 patients with established coronary artery disease (age, 65±9 years; 83% men), 179 (69%) participants showed increased coronary 18F-NaF activity (coronary microcalcification activity>0). Over 53 (40-59) months of follow-up, 18 patients had a myocardial infarction. Using weighted correlation network analysis, we derived 15 distinct eigen radiomic features representing latent morphological coronary plaque patterns in an unsupervised fashion. Following adjustments for calcified, noncalcified, and low-density noncalcified plaque volumes and 18F-NaF coronary microcalcification activity, 4 radiomic features remained independent predictors of myocardial infarction (hazard ratio, 1.46 [95% CI, 1.03-2.08]; P=0.03; hazard ratio, 1.62 [95% CI, 1.04-2.54]; P=0.02; hazard ratio, 1.49 [95% CI, 1.07-2.06]; P=0.01; and hazard ratio, 1.50 (95% CI, 1.05-2.13); P=0.02). CONCLUSIONS In patients with established coronary artery disease, latent coronary plaque morphological features, quantitative plaque volumes, and disease activity on 18F-sodium fluoride positron emission tomography are additive predictors of myocardial infarction.
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Affiliation(s)
- Jacek Kwiecinski
- Departments of Medicine (Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA (J.K., E.T., D.S.B., D.D., P.J.S.)
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland (J.K.)
| | - Márton Kolossváry
- Gottsegen National Cardiovascular Center, Budapest, Hungary (M.K.)
- Physiological Controls Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary (M.K.)
| | - Evangelos Tzolos
- Departments of Medicine (Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA (J.K., E.T., D.S.B., D.D., P.J.S.)
- BHF Centre for Cardiovascular Science (E.T., M.N.M., M.C.W., E.J.R.v.B., D.E.N., M.R.B.), University of Edinburgh, United Kingdom
| | - Mohammed N Meah
- BHF Centre for Cardiovascular Science (E.T., M.N.M., M.C.W., E.J.R.v.B., D.E.N., M.R.B.), University of Edinburgh, United Kingdom
| | - Philip D Adamson
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand (P.D.A.)
| | - Nikhil V Joshi
- Bristol Heart Institute, University of Bristol, United Kingdom (N.V.J.)
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science (E.T., M.N.M., M.C.W., E.J.R.v.B., D.E.N., M.R.B.), University of Edinburgh, United Kingdom
| | - Edwin J R van Beek
- BHF Centre for Cardiovascular Science (E.T., M.N.M., M.C.W., E.J.R.v.B., D.E.N., M.R.B.), University of Edinburgh, United Kingdom
- Edinburgh Imaging, Queens Medical Research Institute (E.J.R.v.B.), University of Edinburgh, United Kingdom
| | - Daniel S Berman
- Departments of Medicine (Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA (J.K., E.T., D.S.B., D.D., P.J.S.)
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary (P.M.-H.)
| | - David E Newby
- BHF Centre for Cardiovascular Science (E.T., M.N.M., M.C.W., E.J.R.v.B., D.E.N., M.R.B.), University of Edinburgh, United Kingdom
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science (E.T., M.N.M., M.C.W., E.J.R.v.B., D.E.N., M.R.B.), University of Edinburgh, United Kingdom
| | - Damini Dey
- Departments of Medicine (Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA (J.K., E.T., D.S.B., D.D., P.J.S.)
| | - Piotr J Slomka
- Departments of Medicine (Artificial Intelligence in Medicine), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA (J.K., E.T., D.S.B., D.D., P.J.S.)
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13
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Agrawal A, Reardon MJ, Goel SS. Transcatheter Mitral Valve Replacement in Patients with Mitral Annular Calcification: A Review. Heart Int 2023; 17:19-26. [PMID: 37456353 PMCID: PMC10339466 DOI: 10.17925/hi.2023.17.1.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/31/2023] [Indexed: 07/18/2023] Open
Abstract
Mitral annular calcification (MAC) is a progressive degenerative calcification of the mitral valve (MV) that is associated with mitral stenosis, regurgitation or both. Patients with MAC are poor candidates for MV surgery because of technical challenges and high peri-operative mortality. Transcatheter MV replacement (TMVR) has emerged as an option for such high surgical risk patients. This has been described with the use of the SAPIEN transcatheter heart valve (valve-in-MAC) and dedicated TMVR devices. Careful anatomic assessment is important to avoid complications of TMVR, such as left ventricular outflow tract obstruction, valve migration, embolization and paravalvular mitral regurgitation. In this review, we discuss the pathology, importance of preprocedural multimodality imaging for optimal patient selection, clinical outcomes and complications associated with TMVR in patients with MAC.
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Affiliation(s)
- Ankit Agrawal
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Michael J Reardon
- Houston Methodist DeBakey Heart and Vascular Institute, Houston, TX, USA
| | - Sachin S Goel
- Houston Methodist DeBakey Heart and Vascular Institute, Houston, TX, USA
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14
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Kumar A, Samra G, Kaur S, Ogunnowo G, Kocyigit D, Xu B. Mitral Annular Calcification Related Infective Endocarditis: A Contemporary Systematic Review. Curr Probl Cardiol 2023; 48:101558. [PMID: 36538998 DOI: 10.1016/j.cpcardiol.2022.101558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
Mitral annular calcification (MAC) is a chronic degenerative process often found incidentally on imaging. MAC is associated with elevated risk of atherosclerosis and stroke. The association between MAC and the risk of infective endocarditis (IE) is less well known. Therefore, we conducted this systematic review in order to understand the diagnosis, clinical outcomes, and management of IE associated with MAC. We conducted a systematic review of published data regarding MAC related IE in various databases until November 20, 2019. Case series and cohort studies were included. A total of 8 studies with a cohort of 113 patients were included. Mean age was 69 years with equal gender distribution (50% female). Hypertension (55.8%) was the most common comorbidity seen in this patient population. IE was diagnosed by either antemortem trans esophageal echocardiographic examination (76%) or post-mortem autopsy (24%). Staphylococcus aureus (47%) was the most common pathogen identified. MAC was adjudicated to be moderate-to-severe in 100% of identified cases, with 77.9% of cases presenting with distinct vegetation's. Twenty-six percent of patients (n = 29) underwent surgery. MAC may be associated with development of IE. Echocardiography is the most common non-invasive technique for diagnosis. Due to the difficulties associated with antemortem diagnosis, diagnosis is occasionally made on post-mortem examination. Neurologic complications are frequently encountered, and reported mortality is high in MAC associated IE.
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Affiliation(s)
- Ashwin Kumar
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH; Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Gursharan Samra
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH
| | - Simrat Kaur
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Gregory Ogunnowo
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Duygu Kocyigit
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH.
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15
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De Azevedo D, Geers J, Gheysens O, Dweck M, Vancraeynest D. 18F-Sodium Fluoride PET/CT in Assessing Valvular Heart and Atherosclerotic Diseases. Semin Nucl Med 2023; 53:241-257. [PMID: 36116988 DOI: 10.1053/j.semnuclmed.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 08/22/2022] [Indexed: 11/11/2022]
Abstract
Aortic valve stenosis is the most common valvular disease in Western countries, while atherosclerotic cardiovascular disease is the foremost cause of death and disability worldwide. Valve degeneration and atherosclerosis are mediated by inflammation and calcification and inevitably progress over time. Computed tomography can visualise the later stages of macroscopic calcification but fails to assess the early stages of microcalcification and cannot differentiate active from burnt out disease states. Molecular imaging has the ability to provide complementary information related to disease activity, which may allow us to detect disease early, to predict disease progression and to monitor preventive or therapeutic strategies for in both aortic stenosis and atherosclerosis. PET/CT is a non-invasive imaging technique that enables visualization of ongoing molecular processes within small structures, such as the coronary arteries or heart valves. 18F-sodium fluoride (18F-NaF) binds hydroxyapatite deposits in the extracellular matrix, with preferential binding to newly developing deposits of microcalcification, which provides an assessment of calcification activity. In recent years, 18F-NaF has attracted the attention of many research groups and has been evaluated in several pathological cardiovascular processes. Histologic validation of the 18F-NaF PET signal in valvular disease and atherosclerosis has been reported in multiple independent studies. The selective high-affinity binding of 18F-NaF to microscopic calcified deposits (beyond the resolution of μCT) has been demonstrated ex vivo, as well as its ability to distinguish between areas of macro- and active microcalcification. In addition, prospective clinical studies have shown that baseline 18F-NaF uptake in patients with aortic stenosis and mitral annular calcification is correlated with subsequent calcium deposition and valvular dysfunction after a follow-up period of 2 years. In patients with surgical bioprosthetic aortic valves but without morphological criteria for prosthetic degeneration, increased 18F-NaF uptake at baseline was associated with subsequent bioprosthetic degeneration over time. Similar data were obtained in a cohort of patients with transcatheter aortic valve implantation. Furthermore, several studies have confirmed the association of coronary 18F-NaF uptake with adverse atherosclerotic plaque features, active disease and future disease progression. 18F-NaF uptake is also associated with future fatal or nonfatal myocardial infarction in patients with established coronary artery disease. The link between 18F-NaF uptake and active atherosclerotic disease has not only been demonstrated in the coronary arteries, but also in peripheral arterial disease, abdominal aortic aneurysms and carotid atherosclerosis. It can be assumed that 18F-NaF PET/CT will strengthen the diagnostic toolbox of practitioners in the coming years. Indeed, there is a strong medical need to diagnose degenerative valvular disease and to detect active atherosclerotic disease states. Finally, the use of 18F-NaF as a biomarker to monitor the efficacy of drug therapies in preventing these pathological processes is attractive. In this review, we consider the role of 18F-NaF PET/CT imaging in cardiac valvular diseases and atherosclerosis.
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Affiliation(s)
- David De Azevedo
- Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, and IREC/CARD UCLouvain, Brussels, Belgium.
| | - Jolien Geers
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, The Chancellor's Building, Little France Crescent, Midlothian, Edinburgh, UK; Department of Cardiology, CHVZ (Centrum voor Hart en Vaatziekten), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Olivier Gheysens
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc and Institute of Clinical and Experimental Research (IREC), Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Marc Dweck
- Department of Cardiology, CHVZ (Centrum voor Hart en Vaatziekten), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - David Vancraeynest
- Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, and IREC/CARD UCLouvain, Brussels, Belgium
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16
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Uzunget SB, Sahin KE. Atherogenic index of plasma is an independent predictor of mitral annular calcification. BMC Cardiovasc Disord 2022; 22:511. [PMID: 36451082 PMCID: PMC9710030 DOI: 10.1186/s12872-022-02891-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/10/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND In the latest reports, atherogenic indices have been related to acute coronary syndromes, stable coronary artery disease, heart failure and future cardiac events. Conventional atherosclerosis risk factors have been associated with mitral annular calcification (MAC), but data on the relationship between atherogenic indices and MAC are lacking. We aimed to investigate a possible relationship between MAC and atherogenic indices. METHODS In total 741 patients (n = 427 with MAC and n = 314 without MAC) who were examined in our cardiology clinic from February 2016 to October 2021 were recruited in the study. Mitral annular calcification was diagnosed by transthoracic 2-dimensional echocardiography. The atherogenic coefficient (AC), Castelli risk index 1 (CRI-1), Castelli risk index 2 (CRI-2) and atherogenic index of plasma (AIP) were calculated by utilizing standard lipid test values. RESULTS There was no statistically significant difference in sex, age, diabetes and hypertension status between the patient and the control groups. Serum triglyceride level, AIP, Hs-CRP, smoking and BMI were independently significantly associated with MAC in multiple regression analysis (p < 0.001). CONCLUSION Higher AIP was related to the existence of MAC and also predict the presence of MAC independently. Studies evaluating the modification of these indices are needed.
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Affiliation(s)
| | - Kader Eliz Sahin
- grid.411126.10000 0004 0369 5557Department of Cardiology, Adiyaman University Education and Research Hospital, Adiyaman, Turkey
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17
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Churchill TW, Yucel E, Deferm S, Levine RA, Hung J, Bertrand PB. Mitral Valve Dysfunction in Patients With Annular Calcification: JACC Review Topic of the Week. J Am Coll Cardiol 2022; 80:739-751. [PMID: 35953139 PMCID: PMC10290884 DOI: 10.1016/j.jacc.2022.05.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 10/15/2022]
Abstract
Mitral annular calcification (MAC) is a common clinical finding and is associated with adverse clinical outcomes, but the clinical impact of MAC-related mitral valve (MV) dysfunction remains underappreciated. Patients with MAC frequently have stenotic, regurgitant, or mixed valvular disease, and this valvular dysfunction is increasingly recognized to be independently associated with worse prognosis. MAC-related MV dysfunction is a distinct pathophysiologic entity, and importantly much of the diagnostic and therapeutic paradigm from published rheumatic MV disease research cannot be applied in this context, leaving important gaps in our knowledge. This review summarizes the current epidemiology, pathophysiology, diagnosis, and classification of MAC-related MV dysfunction and proposes both an integrative definition and an overarching approach to this important and increasingly recognized clinical condition.
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Affiliation(s)
- Timothy W Churchill
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. https://twitter.com/TimChurchillMD
| | - Evin Yucel
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sébastien Deferm
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Robert A Levine
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Judy Hung
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Philippe B Bertrand
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
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Borges-Rosa J, Oliveira-Santos M, Silva R, da Silva NP, Abrunhosa A, Castelo-Branco M, Gonçalves L, Ferreira MJ. Cardiac microcalcification burden: Global assessment in high cardiovascular risk subjects with Na[ 18F]F PET-CT. J Nucl Cardiol 2022; 29:1846-1854. [PMID: 33826127 DOI: 10.1007/s12350-021-02600-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 02/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Fluorine-18 sodium fluoride (Na[18F]F) atherosclerotic plaque uptake in positron emission tomography with computed tomography (PET-CT) identifies active microcalcification. We aim to evaluate global cardiac microcalcification activity with Na[18F]F, as a measure of unstable microcalcification burden, in high cardiovascular (CV) risk patients. METHODS AND RESULTS Thirty-four high CV risk individuals without previous CV events were scanned with Na[18F]F PET-CT. Cardiac Na[18F]F uptake was assessed through the global molecular calcium score (GMCS), which was calculated by summing the product of the mean standardized uptake value times the area of the cardiac regions of interest times the slice thickness for all cardiac transaxial slices, divided by the total number of slices. Mean age is 63.5 ± 7.8 years and 62% male. Median GMCS is 320.9 (240.8-402.8). Individuals with more than five CV risk factors (50%) have increased GMCS [356.7 (321.0-409.6) vs. 261.1 (225.6-342.1), P = 0.01], which is positively correlated with predicted fatal CV risk by SCORE (rs = 0.32, P = 0.04). There is a positive correlation between GMCS and weight (rs = 0.61), body mass index (rs = 0.66), abdominal perimeter (rs = 0.74), thoracic fat volume (rs = 0.47), and epicardial adipose tissue (rs = 0.41), all with P ≤ 0.01. There is no correlation between GMCS and coronary calcium score nor coronary artery wall Na[18F]F uptake. CONCLUSIONS In a high CV risk group, the global cardiac microcalcification burden is related to CV risk factors, metabolic syndrome variables and cardiac fat. Cardiac GMCS is a promising risk stratification tool, combining a straightforward and objective methodology with a comprehensive analysis of both coronary and valvular microcalcification.
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Affiliation(s)
- João Borges-Rosa
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal.
| | - Manuel Oliveira-Santos
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal
- Institute of Nuclear Sciences, Applied to Health - Faculdade de Medicina da Universidade de Coimbra, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal
- Faculdade de Medicina da Universidade de Coimbra, Rua Larga, 3004-504, Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal
| | - Rodolfo Silva
- Institute of Nuclear Sciences, Applied to Health - Faculdade de Medicina da Universidade de Coimbra, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal
- Faculdade de Medicina da Universidade de Coimbra, Rua Larga, 3004-504, Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal
| | - Nuno Pereira da Silva
- Radiology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal
| | - Antero Abrunhosa
- Institute of Nuclear Sciences, Applied to Health - Faculdade de Medicina da Universidade de Coimbra, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal
- Faculdade de Medicina da Universidade de Coimbra, Rua Larga, 3004-504, Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal
| | - Miguel Castelo-Branco
- Institute of Nuclear Sciences, Applied to Health - Faculdade de Medicina da Universidade de Coimbra, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal
- Faculdade de Medicina da Universidade de Coimbra, Rua Larga, 3004-504, Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal
| | - Lino Gonçalves
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal
- Faculdade de Medicina da Universidade de Coimbra, Rua Larga, 3004-504, Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal
| | - Maria João Ferreira
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal
- Institute of Nuclear Sciences, Applied to Health - Faculdade de Medicina da Universidade de Coimbra, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal
- Faculdade de Medicina da Universidade de Coimbra, Rua Larga, 3004-504, Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal
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Yedidya I, Butcher SC, Stassen J, van der Bijl P, Ngiam JN, Chew NWS, Sia CH, Leow R, Li TYW, Kong WKF, Poh KK, Kornowski R, Marsan NA, Delgado V, Bax JJ. Prognostic value of left atrial volume index in degenerative mitral stenosis. Int J Cardiovasc Imaging 2022; 38:2687-2693. [DOI: 10.1007/s10554-022-02691-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/01/2022] [Indexed: 11/05/2022]
Abstract
Abstract
Purpose
Degenerative mitral stenosis (DMS) is associated with a poor prognosis. Although mean transmitral gradient (TMG) has shown a good correlation with outcome, little is known about the association between other echocardiographic parameters and prognosis in patients with DMS. The current study aimed to evaluate the prognostic value of left atrial volume index (LAVI) in patients with DMS.
Methods
A total of 155 patients with DMS (72[63–80] years, 67% female) were included. The population was divided according to LAVI: normal-sized LAVI (LAVI ≤ 34 ml/m2); and enlarged LAVI (> 34 ml/m2).
Results
Patients with enlarged LAVI had a higher left ventricular mass index (120[96–146] vs. 91[70–112] g/m2 p < 0.001), as well as a higher prevalence of significant mitral regurgitation and severe aortic stenosis (23% vs. 10% p = 0.046 and 38% vs. 15% p=0.001, respectively) compared to patients with normal-sized LAVI. During a median follow-up of 25 months, 56 (36%) patients died. Patients with enlarged LAVI had worse prognosis compared to patients with normal-sized LAVI (p = 0.026). In multivariable Cox regression model, an enlarged LAVI was independently associated with all-cause mortality (HR 2.009, 95% CI 1.040 to 3.880, P = 0.038).
Conclusion
An enlarged LAVI (> 34 ml/m2) is significantly associated with excess mortality in patients with DMS. After adjusting for potential confounders, an enlarged LAVI was the only parameter that remained independently associated with prognosis.
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20
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Stendahl JC, Kwan JM, Pucar D, Sadeghi MM. Radiotracers to Address Unmet Clinical Needs in Cardiovascular Imaging, Part 2: Inflammation, Fibrosis, Thrombosis, Calcification, and Amyloidosis Imaging. J Nucl Med 2022; 63:986-994. [PMID: 35772956 PMCID: PMC9258561 DOI: 10.2967/jnumed.121.263507] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 02/22/2022] [Indexed: 01/03/2023] Open
Abstract
Cardiovascular imaging is evolving in response to systemwide trends toward molecular characterization and personalized therapies. The development of new radiotracers for PET and SPECT imaging is central to addressing the numerous unmet diagnostic needs that relate to these changes. In this 2-part review, we discuss select radiotracers that may help address key unmet clinical diagnostic needs in cardiovascular medicine. Part 1 examined key technical considerations pertaining to cardiovascular radiotracer development and reviewed emerging radiotracers for perfusion and neuronal imaging. Part 2 covers radiotracers for imaging cardiovascular inflammation, thrombosis, fibrosis, calcification, and amyloidosis. These radiotracers have the potential to address several unmet needs related to the risk stratification of atheroma, detection of thrombi, and the diagnosis, characterization, and risk stratification of cardiomyopathies. In the first section, we discuss radiotracers targeting various aspects of inflammatory responses in pathologies such as myocardial infarction, myocarditis, sarcoidosis, atherosclerosis, and vasculitis. In a subsequent section, we discuss radiotracers for the detection of systemic and device-related thrombi, such as those targeting fibrin (e.g., 64Cu-labeled fibrin-binding probe 8). We also cover emerging radiotracers for the imaging of cardiovascular fibrosis, such as those targeting fibroblast activation protein (e.g., 68Ga-fibroblast activation protein inhibitor). Lastly, we briefly review radiotracers for imaging of cardiovascular calcification (18F-NaF) and amyloidosis (e.g., 99mTc-pyrophosphate and 18F-florbetapir).
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Affiliation(s)
- John C Stendahl
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Jennifer M Kwan
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Darko Pucar
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut; and
| | - Mehran M Sadeghi
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut;
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
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21
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Lak HM, Chawla S, Gajulapalli RD, Verma BR, Ahmed T, Agrawal A, Kumar S, Alkhalaileh F, Ghimire B, Shekhar S, Gad M, Bansal A, Layoun H, Nair R, Yun J, Unai S, Pettersson GB, Reed GW, Puri R, Krishnaswamy A, Harb SC, Kapadia SR. Comparison of Outcomes of Transcatheter Aortic Valve Implantation in Patients With Versus Without Mitral Annular Calcium. Am J Cardiol 2022; 180:99-107. [DOI: 10.1016/j.amjcard.2022.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/01/2022] [Accepted: 06/08/2022] [Indexed: 11/26/2022]
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22
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Postalian A, Krajcer Z. Mitral annular calcification-A marker of risk, and a harbinger of technical challenges during intervention. Catheter Cardiovasc Interv 2022; 99:1817-1818. [PMID: 35568978 DOI: 10.1002/ccd.30216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Alexander Postalian
- Department of Cardiology, Texas Heart Institute, Houston, Texas, USA.,Division of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Zvonimir Krajcer
- Department of Cardiology, Texas Heart Institute, Houston, Texas, USA.,Division of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
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Extracorporeal Membrane Oxygenation-Supported Transcatheter Mitral Valve-in-Valve Replacement and Paravalvular Plugging for Critical Prosthetic Mitral Stenosis. JACC Case Rep 2022; 4:491-496. [PMID: 35493798 PMCID: PMC9044295 DOI: 10.1016/j.jaccas.2022.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/21/2022] [Accepted: 02/15/2022] [Indexed: 11/24/2022]
Abstract
We present the case of a patient with rapidly progressive bioprosthetic mitral valve stenosis in the setting of end-stage renal failure. Critical valve stenosis led to cardiogenic shock requiring full hemodynamic support. Emergent extracorporeal membrane oxygenation–supported transcatheter mitral valve-in-valve implantation was successfully undertaken as a life-saving measure with an excellent final result. (Level of Difficulty: Advanced.)
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24
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Tzolos E, Kwiecinski J, Lassen ML, Cadet S, Adamson PD, Moss AJ, Joshi N, Williams MC, van Beek EJR, Dey D, Berman DS, Dweck MR, Newby DE, Slomka PJ. Observer repeatability and interscan reproducibility of 18F-sodium fluoride coronary microcalcification activity. J Nucl Cardiol 2022; 29:126-135. [PMID: 32529531 PMCID: PMC7728624 DOI: 10.1007/s12350-020-02221-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/28/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND We aimed to establish the observer repeatability and interscan reproducibility of coronary 18F-sodium-fluoride positron emission tomography (PET) uptake using a novel semi-automated approach, coronary microcalcification activity (CMA). METHODS Patients with multivessel coronary artery disease underwent repeated hybrid PET and computed tomography angiography (CTA) imaging (PET/CTA). CMA was defined as the integrated standardized uptake values (SUV) in the entire coronary tree exceeding 2 standard deviations above the background SUV. Coefficients of repeatability between the same observer (intraobserver repeatability), between 2 observers (interobserver repeatability) and coefficient of reproducibility between 2 scans (interscan reproducibility), were determined at vessel and patient level. RESULTS In 19 patients, CMA was assessed twice in 43 coronary vessels on two PET/CT scans performed 12 ± 5 days apart. There was excellent intraclass correlation for intraobserver and interobserver repeatability as well as interscan reproducibility (all ≥ 0.991). There was 100% intraobserver, interobserver and interscan agreement for the presence (CMA > 0) or absence (CMA = 0) of coronary18F-NaF uptake. Mean CMA was 3.12 ± 0.62 with coefficients of repeatability of ≤ 10% for all measures: intraobserver 0.24 and 0.22, interobserver 0.30 and 0.29 and interscan 0.33 and 0.32 at a per-vessel and per-patient level, respectively. CONCLUSIONS CMA is a repeatable and reproducible global measure of coronary atherosclerotic activity.
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Affiliation(s)
- Evangelos Tzolos
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Ste A047N, Los Angeles, CA, 90048, USA
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Jacek Kwiecinski
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Ste A047N, Los Angeles, CA, 90048, USA
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Martin Lyngby Lassen
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Ste A047N, Los Angeles, CA, 90048, USA
| | - Sebastien Cadet
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Ste A047N, Los Angeles, CA, 90048, USA
| | - Philip D Adamson
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Alastair J Moss
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- BHF Cardiovascular Research Centre, University of Leicester, Leicester, UK
| | - Nikhil Joshi
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- BHF Cardiovascular Research Centre, University of Leicester, Leicester, UK
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Edwin J R van Beek
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Damini Dey
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Ste A047N, Los Angeles, CA, 90048, USA
| | - Daniel S Berman
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Ste A047N, Los Angeles, CA, 90048, USA
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- BHF Cardiovascular Research Centre, University of Leicester, Leicester, UK
| | - Piotr J Slomka
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Ste A047N, Los Angeles, CA, 90048, USA.
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Bagaev E, Ali A, Saha S, Sadoni S, Orban M, Naebauer M, Mehilli J, Massberg S, Oberbach A, Hagl C. Hybrid Surgery for Severe Mitral Valve Calcification: Limitations and Caveats for an Open Transcatheter Approach. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:93. [PMID: 35056401 PMCID: PMC8777627 DOI: 10.3390/medicina58010093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/28/2021] [Accepted: 12/31/2021] [Indexed: 11/24/2022]
Abstract
Background and Objectives: Mitral stenosis with extensive mitral annular calcification (MAC) remains surgically challenging in respect to clinical outcome. Prolonged surgery time with imminent ventricular rupture and systolic anterior motion can be considered as a complex of causal factors. The aim of our alternative hybrid approach was to reduce the risk of annual rupture and paravalvular leaks and to avoid obstruction of the outflow tract. A review of the current literature was also carried out. Materials and Methods: Six female patients (mean age 76 ± 9 years) with severe mitral valve stenosis and severely calcified annulus underwent an open implantation of an Edwards Sapien 3 prosthesis on cardiopulmonary bypass. Our hybrid approach involved resection of the anterior mitral leaflet, placement of anchor sutures and the deployment of a balloon expanded prosthesis under visual control. Concomitant procedures were carried out in three patients. Results: The mean duration of cross-clamping was 95 ± 31 min and cardiopulmonary bypass was 137 ± 60 min. The perioperative TEE showed in three patients an inconspicuous, heart valve-typical gradient on all implanted prostheses and a clinically irrelevant paravalvular leakage occurred in the anterior annulus. In the left ventricular outflow tract, mild to moderately elevated gradients were recorded. No adverse cerebrovascular events and pacemaker implantations were observed. All but one patient survived to discharge. Survival at one year was 83.3%. Conclusions: This "off label" implantation of the Edwards Sapien 3 prosthesis may be considered as a suitable bail-out approach for patients at high-risk for mitral valve surgery or deemed inoperable due to extensive MAC.
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Affiliation(s)
- Erik Bagaev
- German Centre for Cardiovascular Research (DZHK), Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, 80539 Munich, Germany; (E.B.); (A.A.); (S.S.); (A.O.); (C.H.)
- Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, 90471 Nuremberg, Germany
| | - Ahmad Ali
- German Centre for Cardiovascular Research (DZHK), Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, 80539 Munich, Germany; (E.B.); (A.A.); (S.S.); (A.O.); (C.H.)
| | - Shekhar Saha
- German Centre for Cardiovascular Research (DZHK), Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, 80539 Munich, Germany; (E.B.); (A.A.); (S.S.); (A.O.); (C.H.)
| | - Sebastian Sadoni
- German Centre for Cardiovascular Research (DZHK), Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, 80539 Munich, Germany; (E.B.); (A.A.); (S.S.); (A.O.); (C.H.)
| | - Martin Orban
- German Centre for Cardiovascular Research (DZHK), Department of Cardiology, Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, 80539 Munich, Germany; (M.O.); (M.N.); (J.M.); (S.M.)
| | - Michael Naebauer
- German Centre for Cardiovascular Research (DZHK), Department of Cardiology, Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, 80539 Munich, Germany; (M.O.); (M.N.); (J.M.); (S.M.)
| | - Julinda Mehilli
- German Centre for Cardiovascular Research (DZHK), Department of Cardiology, Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, 80539 Munich, Germany; (M.O.); (M.N.); (J.M.); (S.M.)
- Medizinische Klinik I, Landshut-Achdorf Hospital, 84036 Landshut, Germany
| | - Steffen Massberg
- German Centre for Cardiovascular Research (DZHK), Department of Cardiology, Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, 80539 Munich, Germany; (M.O.); (M.N.); (J.M.); (S.M.)
| | - Andreas Oberbach
- German Centre for Cardiovascular Research (DZHK), Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, 80539 Munich, Germany; (E.B.); (A.A.); (S.S.); (A.O.); (C.H.)
| | - Christian Hagl
- German Centre for Cardiovascular Research (DZHK), Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, 80539 Munich, Germany; (E.B.); (A.A.); (S.S.); (A.O.); (C.H.)
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Sveric KM, Platzek I, Golgor E, Hoffmann RT, Linke A, Jellinghaus S. Purposeful use of multimodality imaging in the diagnosis of caseous mitral annular calcification: a case series report. BMC Med Imaging 2022; 22:7. [PMID: 34991503 PMCID: PMC8734157 DOI: 10.1186/s12880-021-00725-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 12/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Caseous mitral annular calcification (CMAC) is a rare liquefactive variant of mitral annular calcification (MAC) and superficially mimics a cardiac vegetation or abscess. CMAC is viewed as a benign condition of MAC, while MAC has clinical implications for patients' lives. Correctly diagnosing CMAC is essential in order to avoid unnecessary interventions, cardiac surgery or even psychological suffering for the patient. CASE PRESENTATION We report on 6 patients with suspected intra-cardiac masses of the mitral annulus that were referred to our institution for further clarification. A definitive diagnosis of CMAC was achieved by combining echocardiography (Echo), cardiac magnetic resonance imaging (MRI) and cardiac computed tomography (CT) for these patients. Echo assessed the mass itself and possible interactions with the mitral valve. MRI was useful in differentiating the tissue from other benign or malign neoplasms. CT revealed the typical structure of CMAC with a "soft" liquefied centre and an outer capsule with calcification. CONCLUSION CMAC is a rare condition, and most clinicians and even radiologists are not familiar with it. CMAC can be mistaken for an intra-cardiac tumour, thombus, vegetation, or abscess. Non-invasive multimodality imaging (i.e. Echo, MRI, and CT) helps to establish a definitive diagnosis of CMAC and avoid unnecessary interventions especially in uncertain cases.
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Affiliation(s)
- Krunoslav Michael Sveric
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Fetscherstr. 76, 01307, Dresden, Germany.
| | - Ivan Platzek
- Insitute and Polyclinic for Diagnostic and Interventional Radiology, Dresden University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Elena Golgor
- Insitute and Polyclinic for Diagnostic and Interventional Radiology, Dresden University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Ralf-Thorsten Hoffmann
- Insitute and Polyclinic for Diagnostic and Interventional Radiology, Dresden University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Axel Linke
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Fetscherstr. 76, 01307, Dresden, Germany
| | - Stefanie Jellinghaus
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Fetscherstr. 76, 01307, Dresden, Germany
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Mitral annular calcification in hypertrophic cardiomyopathy. Int J Cardiol 2021; 349:83-89. [PMID: 34848211 DOI: 10.1016/j.ijcard.2021.11.058] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/26/2021] [Accepted: 11/24/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Changes in mitral valve anatomy contribute to left ventricular outflow tract obstruction (LVOTO) in hypertrophic cardiomyopathy (HCM). Mitral annular calcification (MAC) is common among patients with HCM but its implications are currently unknown. METHODS We tested the hypothesis that echocardiographic MAC would be associated with anterior displacement of the mitral valve and LVOTO in a cohort of 304 patients with HCM aged ≥ 60 years (mean [SD] age 71.6 [7.7] years, 52% women). RESULTS MAC was present in 141 (46%) patients. The mean (SD) MAC offset distance was 9.8 (4.8) mm. A higher proportion of those with MAC compared to those without MAC had SAM (84.2 vs. 63.8%, p < 0.001) and LVOTO (80.9 vs. 57.9%, p < 0.001). In patients with MAC, the septal-mitral valve distance was shorter compared to those without (19.4 [4.0] vs 21.5 [4.9] mm, p < 0.001). The mitral valve position ratio was greater in those with MAC compared to those without (1.00 [0.79, 1.22] vs. 0.86 [0.67, 1.05], p < 0.001) denoting greater anterior displacement, especially in those with MAC and LVOTO. After multivariable adjustment, MAC offset distance was associated with LVOTO (OR 1.16 [95% CI 1.07, 1.28] per mm, p = 0.001). Over a median follow-up of 2.7 years, 42 (29.8%) patients with MAC underwent surgery to relieve LVOTO, with no deaths. CONCLUSION This study adds MAC to the known geometrical alterations of the mitral valve that predispose to LVOTO and suggests that surgical relief of LVOTO in the presence of MAC is safe when performed by an experienced surgeon.
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Seo J, Jeong H, Cho I, Hong GR, Ha JW, Shim CY. Sex Differences in Mitral Annular Calcification and the Clinical Implications. Front Cardiovasc Med 2021; 8:736040. [PMID: 34722668 PMCID: PMC8551453 DOI: 10.3389/fcvm.2021.736040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 09/22/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Heterogeneous mechanisms may contribute to the occurrence of mitral annular calcification (MAC), however, little is known about the sex differences in MAC and the clinical implications of these differences. This study aimed to investigate clinical and imaging differences of MAC according to sex. Methods: In total, 537 patients (221 men) with MAC were identified by transthoracic echocardiography at a single center from January 2012 to June 2016. Moderate-to-severe MAC was defined as calcification extent ≥120° of the mitral annulus. Significant functional mitral stenosis (MS) was defined as a transmitral mean diastolic pressure gradient ≥5 mmHg. Results: Women more frequently had moderate-to-severe MAC and concomitant mitral regurgitation than men; however, significant functional MS was comparable between sexes. In the logistic regression analysis, old age, uncontrolled hypertension, end-stage renal disease (ESRD), and obstructive hypertrophic cardiomyopathy were significantly associated with moderate-to-severe MAC in women, whereas ESRD and moderate-to-severe aortic stenosis were in men. In the Cox regression analysis, significant functional MS was associated with all-cause death in both sexes, although an independent association was found in only women. Conclusion: Women had more extended MAC than men. Significant functional MS was independently associated with unfavorable clinical outcomes in patients with MAC, which was more pronounced in women than in men.
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Affiliation(s)
- Jiwon Seo
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyeonju Jeong
- Division of Cardiology, Department of Internal Medicine, Myongji Hospital, Hanyang University Medical Center, Seoul, South Korea
| | - Iksung Cho
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Geu-Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong-Won Ha
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
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You T, Wang W, Yi K, Gao J, Zhang X, He SE, Xu XM, Ma YH, Li XY. Transcatheter mitral valve replacement for degenerated mitral valve bioprostheses, failure of mitral valvuloplasty and native valve with severe mitral annulus calcification: a systematic review and meta-analysis. J Cardiothorac Surg 2021; 16:293. [PMID: 34629106 PMCID: PMC8504093 DOI: 10.1186/s13019-021-01677-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/28/2021] [Indexed: 01/04/2023] Open
Abstract
Background Although transcatheter technology has achieved some success in the field of mitral valves, the feasibility of applying it to patients with degenerated mitral valve bioprostheses (valve-in-valve, ViV), failure of mitral valvuloplasty (valve-in-ring, ViR) and serious mitral annulus calcification (vale-in-MAC, ViMAC) has not been effectively evaluated. Methods By searching published literature before December 5, 2020 in four databases, we found all the literature related to the evaluation of feasibility assessment of TMViV, TMViR and TMViMAC. Outcomes focused on all-cause mortality within 30 days, bleeding and LVOT obstruction. Results A total of six studies were included, and all of them were followed up for at least 30 days. After analysis of the ViV–ViR group, we obtained the following results: the all-cause mortality within 30 days of the ViV group was lower than that of the ViR group. Life-threatening or fatal bleeding was more likely to occur in the ViR group after surgery. At the same time, the ViR group was more prone to left ventricular outflow tract obstruction. However, in the ViMAC–ViR group, only the all-cause mortality within 30 days and stroke were statistically significant. In the indirect comparison, we found that TMViV had the best applicability, followed by TMViR. There were few TMViMAC available for analysis, and it requires further studies to improve the accuracy of the results. Conclusion TMViV and TMViR had good applicability and could benefit patients who underwent repeat valve surgery. The feasibility of TMViMAC needs to be further explored and improved. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01677-7.
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Affiliation(s)
- Tao You
- Department of Cardiovascular Surgery, Gansu Provincial Hospital, No. 204, Donggang West Road, Lanzhou City, 730000, Gansu Province, China. .,Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China.
| | - Wei Wang
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China.,The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Kang Yi
- Department of Cardiovascular Surgery, Gansu Provincial Hospital, No. 204, Donggang West Road, Lanzhou City, 730000, Gansu Province, China.,Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China
| | - Jie Gao
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China.,The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Xin Zhang
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China.,The First School of Clinical Medical of Gansu University of Chinese Medicine, Lanzhou, China
| | - Shao-E He
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China.,The Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Xiao-Min Xu
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China.,The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Yu-Hu Ma
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China.,The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Xin-Yao Li
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China.,The First Clinical Medical College of Lanzhou University, Lanzhou, China
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30
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Akerele MI, Karakatsanis NA, Forsythe RO, Dweck MR, Syed M, Aykroyd RG, Sourbron S, Newby DE, Tsoumpas C. Iterative reconstruction incorporating background correction improves quantification of [ 18F]-NaF PET/CT images of patients with abdominal aortic aneurysm. J Nucl Cardiol 2021; 28:1875-1886. [PMID: 31721093 PMCID: PMC8648624 DOI: 10.1007/s12350-019-01940-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 10/16/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND A confounding issue in [18F]-NaF PET/CT imaging of abdominal aortic aneurysms (AAA) is the spill in contamination from the bone into the aneurysm. This study investigates and corrects for this spill in contamination using the background correction (BC) technique without the need to manually exclude the part of the AAA region close to the bone. METHODS Seventy-two (72) datasets of patients with AAA were reconstructed with the standard ordered subset expectation maximization (OSEM) algorithm incorporating point spread function (PSF) modelling. The spill in effect in the aneurysm was investigated using two target regions of interest (ROIs): one covering the entire aneurysm (AAA), and the other covering the aneurysm but excluding the part close to the bone (AAAexc). ROI analysis was performed by comparing the maximum SUV in the target ROI (SUVmax(T)), the corrected cSUVmax (SUVmax(T) - SUVmean(B)) and the target-to-blood ratio (TBR = SUVmax(T)/SUVmean(B)) with respect to the mean SUV in the right atrium region. RESULTS There is a statistically significant higher [18F]-NaF uptake in the aneurysm than normal aorta and this is not correlated with the aneurysm size. There is also a significant difference in aneurysm uptake for OSEM and OSEM + PSF (but not OSEM + PSF + BC) when quantifying with AAA and AAAexc due to the spill in from the bone. This spill in effect depends on proximity of the aneurysms to the bone as close aneurysms suffer more from spill in than farther ones. CONCLUSION The background correction (OSEM + PSF + BC) technique provided more robust AAA quantitative assessments regardless of the AAA ROI delineation method, and thus it can be considered as an effective spill in correction method for [18F]-NaF AAA studies.
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Affiliation(s)
- Mercy I Akerele
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9NL, UK
| | - Nicolas A Karakatsanis
- Division of Radiopharmaceutical Sciences, Department of Radiology, Weil Cornell Medical College of Cornell University, New York, NY, USA
| | - Rachael O Forsythe
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging Facility, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging Facility, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Maaz Syed
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging Facility, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | | | - Steven Sourbron
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9NL, UK
| | - David E Newby
- Edinburgh Imaging Facility, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Charalampos Tsoumpas
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9NL, UK.
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31
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Massera D, Buzkova P, Bortnick AE, Owens DS, Mao S, Li D, De Boer IH, Kestenbaum BR, Budoff MJ, Kizer JR. Bone mineral density and long-term progression of aortic valve and mitral annular calcification: The Multi-Ethnic Study of Atherosclerosis. Atherosclerosis 2021; 335:126-134. [PMID: 34511241 DOI: 10.1016/j.atherosclerosis.2021.08.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 08/12/2021] [Accepted: 08/18/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Bone and mineral metabolism has been implicated in the pathophysiology of cardiac valve calcification. Whether bone demineralization, a common aging-related disorder, promotes calcific valve disease remains uncertain. We tested the hypothesis that low bone mineral density (BMD) is associated with greater incidence/progression of cardiac valve calcification in the Multi-Ethnic Study of Atherosclerosis. METHODS Using linear mixed-effects models, we related baseline measurement of BMD of the thoracic vertebrae by computed tomography (CT) in 6768 participants to serial CT assessments of aortic valve calcification (AVC) and mitral annular calcification (MAC) obtained over a >10-year period. RESULTS After multivariable adjustment, lower BMD (per SD decrement) was associated with accelerated increase in AVC over time in women (0.76 [95% CI 0.42,1.09] Agatston -units [AU]/year) and men (1.41 [95% CI 0.48,2.33] AU/year), as well as for MAC in women (3.22 [95% CI 1.16,5.28] AU/year) and men (3.59 [95% CI 2.09,5.09] AU/year). Significant effect modification was observed, with more pronounced BMD-related acceleration of AVC and MAC progression in older or white participants of one or both sexes, as well as by estimated glomerular filtration rate, though the latter differed by sex for AVC and MAC. CONCLUSIONS In this multi-ethnic cohort, low thoracic BMD was significantly, but modestly, associated with increased AVC and MAC progression. This suggests that altered bone mineral metabolism does not have a major impact on calcific valve disease in the general population, but the possibility of a more meaningful influence in higher-risk individuals with osteoporosis will require further investigation.
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Affiliation(s)
- Daniele Massera
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, New York, NY, USA.
| | - Petra Buzkova
- Department of Biostatistics, University of Washington, Seattle, WA, USA.
| | - Anna E Bortnick
- Divisions of Cardiology and Geriatrics, Montefiore Medical Center, Bronx, NY, USA.
| | - David S Owens
- Division of Cardiology, University of Washington, Seattle, WA, USA.
| | - SongShou Mao
- Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA.
| | - Dong Li
- Division of Hospital Medicine, Emory University, Atlanta, GA, USA.
| | - Ian H De Boer
- Division of Nephrology and Kidney Research Institute, Department of Medicine, University of Washington, Seattle, WA, USA.
| | - Bryan R Kestenbaum
- Division of Nephrology and Kidney Research Institute, Department of Medicine, University of Washington, Seattle, WA, USA.
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA.
| | - Jorge R Kizer
- Cardiology Section, San Francisco Veterans Affairs Health Care System, and Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
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32
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Xu B, Kocyigit D, Wang TKM, Tan CD, Rodriguez ER, Pettersson GB, Unai S, Griffin BP. Mitral annular calcification and valvular dysfunction: multimodality imaging evaluation, grading, and management. Eur Heart J Cardiovasc Imaging 2021; 23:e111-e122. [PMID: 34591959 DOI: 10.1093/ehjci/jeab185] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/02/2021] [Indexed: 11/12/2022] Open
Abstract
Mitral annular calcification (MAC) refers to calcium deposition in the fibrous skeleton of the mitral valve. It has many cardiovascular associations, including mitral valve dysfunction, elevated cardiovascular risk, arrhythmias, and endocarditis. Echocardiography conventionally is the first-line imaging modality for anatomic assessment, and evaluation of mitral valve function. Cardiac computed tomography (CT) has demonstrated importance as an imaging modality for the evaluation and planning of related procedures. It also holds promise in quantitative grading of MAC. Currently, there is no universally accepted definition or classification system of MAC severity. We review the multimodality imaging evaluation of MAC and associated valvular dysfunction and propose a novel classification system based on qualitative and quantitative measurements derived from echocardiography and cardiac CT.
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Affiliation(s)
- Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH 44195, USA
| | - Duygu Kocyigit
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH 44195, USA
| | - Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH 44195, USA
| | - Carmela D Tan
- Department of Cardiovascular Anatomical Pathology, Cleveland Clinic, Cleveland, OH 44195, USA
| | - E Rene Rodriguez
- Department of Cardiovascular Anatomical Pathology, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Brian P Griffin
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH 44195, USA
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33
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How to Manage Mitral Stenosis Due to Mitral Annular Calcification. Curr Cardiol Rep 2021; 23:148. [PMID: 34427785 DOI: 10.1007/s11886-021-01567-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW Mitral annular calcification (MAC) is associated with cardiovascular comorbidities and events and in the presence of mitral stenosis (MS) represents a high-risk cohort with limited treatment options. Emerging hybrid, minimally invasive, and transcatheter therapies that use circumferential MAC as an anchor for mitral valve replacement are emerging, but none are consistently associated with ideal outcomes. RECENT FINDINGS In patients with MAC and nonrheumatic calcific mitral stenosis who are severely symptomatic, mitral intervention may be indicated. Surgical decalcification and replacement of the mitral valve remains the conventional therapy. Surgical techniques to avoid decalcification are being described including a left atrium to left ventricular apex graft conduit. Transcatheter balloon-expandable valves designed for the aortic valve have been implanted in the mitral position in MAC with a surgical direct transatrial transcatheter approach or transseptal transcatheter approach. Left ventricular outflow tract (LVOT) obstruction remains prevalent and associated with increased mortality. Direct transatrial approach allows for surgical resection of the anterior leaflet to mitigate this risk, and percutaneous therapies to lacerate the anterior leaflet or to ablate the basal septum are being developed. Cardiac computed tomography has emerged as a requisite for patient selection and procedural planning and has powerful predictive value for LVOT obstruction and valve embolization in valve-in-MAC. Novel transcatheter valves designed specifically for the mitral space are being studied in patients with MAC. MAC with mitral stenosis remains a challenging disease. Advances in technique, technology, and imaging may create new and reproducible treatment options with low procedural mortality for this challenging disease entity.
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34
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Birudaraju D, Cherukuri L, Pranesh S, Budoff MJ. Current methods to assess mitral annular calcification and its risk factors. Expert Rev Cardiovasc Ther 2021; 19:787-800. [PMID: 34348555 DOI: 10.1080/14779072.2021.1964361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Mitral annulus calcification (MAC) is a chronic, non-inflammatory, degenerative mechanism of the fibrous base of the mitral valve. While MAC was originally thought to be an age-related degenerative process, there is evidence that other mechanisms, such as atherosclerosis and abnormal calcium phosphorus metabolism, also contribute to the development of MAC. AREAS COVERED This paper summarizes, existing perception of clinically valid definition of MAC and the pathophysiological processes that lead to the development of MAC and the diagnostic implications of this disease entity. EXPERT OPINION Minimal evidence exists on the natural history and progression of MAC. Characterization of MAC progression and identification of predisposing risk factors can help to validate hypotheses. MAC is most commonly asymptomatic and incidental finding. Echocardiography is the primary imaging modality for identification and characterization of MAC and associated mitral valve (MV) disease. For patients with an indication for MV surgery, computed tomography (CT) is a complementary imaging modality for MAC. MAC is generally recognized by its characteristic density, location, and shape on echocardiography and CT, unusual variants are sometimes confused with other lesions.
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Affiliation(s)
- Divya Birudaraju
- Division Of Cardiology, Lundquist Institute For Biomedical Innovation At Harbor-UCLA, Torrance, California, USA
| | - Lavanya Cherukuri
- Division Of Cardiology, Lundquist Institute For Biomedical Innovation At Harbor-UCLA, Torrance, California, USA
| | - Shruthi Pranesh
- Division Of Cardiology, Penn State Holy Spirit Hospital, Harrisburg, Pennsylvania, USA
| | - Matthew J Budoff
- Division Of Cardiology, Lundquist Institute For Biomedical Innovation At Harbor-UCLA, Torrance, California, USA
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35
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Cohen A, Donal E, Delgado V, Pepi M, Tsang T, Gerber B, Soulat-Dufour L, Habib G, Lancellotti P, Evangelista A, Cujec B, Fine N, Andrade MJ, Sprynger M, Dweck M, Edvardsen T, Popescu BA. EACVI recommendations on cardiovascular imaging for the detection of embolic sources: endorsed by the Canadian Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2021; 22:e24-e57. [PMID: 33709114 DOI: 10.1093/ehjci/jeab008] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/07/2021] [Indexed: 12/28/2022] Open
Abstract
Cardioaortic embolism to the brain accounts for approximately 15-30% of ischaemic strokes and is often referred to as 'cardioembolic stroke'. One-quarter of patients have more than one cardiac source of embolism and 15% have significant cerebrovascular atherosclerosis. After a careful work-up, up to 30% of ischaemic strokes remain 'cryptogenic', recently redefined as 'embolic strokes of undetermined source'. The diagnosis of cardioembolic stroke remains difficult because a potential cardiac source of embolism does not establish the stroke mechanism. The role of cardiac imaging-transthoracic echocardiography (TTE), transoesophageal echocardiography (TOE), cardiac computed tomography (CT), and magnetic resonance imaging (MRI)-in the diagnosis of potential cardiac sources of embolism, and for therapeutic guidance, is reviewed in these recommendations. Contrast TTE/TOE is highly accurate for detecting left atrial appendage thrombosis in patients with atrial fibrillation, valvular and prosthesis vegetations and thrombosis, aortic arch atheroma, patent foramen ovale, atrial septal defect, and intracardiac tumours. Both CT and MRI are highly accurate for detecting cavity thrombosis, intracardiac tumours, and valvular prosthesis thrombosis. Thus, CT and cardiac magnetic resonance should be considered in addition to TTE and TOE in the detection of a cardiac source of embolism. We propose a diagnostic algorithm where vascular imaging and contrast TTE/TOE are considered the first-line tool in the search for a cardiac source of embolism. CT and MRI are considered as alternative and complementary tools, and their indications are described on a case-by-case approach.
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Affiliation(s)
- Ariel Cohen
- Assistance Publique-Hôpitaux de Paris, Saint-Antoine and Tenon Hospitals, Department of Cardiology, and Sorbonne University, Paris, France.,INSERM unit UMRS-ICAN 1166; Sorbonne-Université, Paris, France
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, 20141, Milan, Italy
| | - Teresa Tsang
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bernhard Gerber
- Service de Cardiologie, Département Cardiovasculaire, Cliniques Universitaires St. Luc, Division CARD, Institut de Recherche Expérimental et Clinique (IREC), UCLouvainAv Hippocrate 10/2803, B-1200 Brussels, Belgium
| | - Laurie Soulat-Dufour
- Assistance Publique-Hôpitaux de Paris, Saint-Antoine and Tenon Hospitals, Department of Cardiology, and Sorbonne University, Paris, France.,INSERM unit UMRS-ICAN 1166; Sorbonne-Université, Paris, France
| | - Gilbert Habib
- Aix Marseille Univ, IRD, MEPHI, IHU-Méditerranée Infection, APHM, La Timone Hospital, Cardiology Department, Marseille, France
| | - Patrizio Lancellotti
- University of Liège Hospital, GIGA Cardiovascular Sciences, Department of Cardiology, CHU SartTilman, Liège, Belgium.,Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | - Arturo Evangelista
- Servei de Cardiologia. Hospital Universitari Vall d'Hebron-VHIR. CIBER-CV. Pº Vall d'Hebron 119. 08035. Barcelona. Spain
| | - Bibiana Cujec
- Division of Cardiology, University of Alberta, 2C2.50 Walter Mackenzie Health Sciences Center, 8440 112 St NW, Edmonton, Alberta, Canada T6G 2B7
| | - Nowell Fine
- University of Calgary, Libin Cardiovascular Institute, South Health Campus, 4448 Front Street Southeast, Calgary, Alberta T3M 1M4, Canada
| | - Maria Joao Andrade
- Maria Joao Andrade Cardiology Department, Hospital de Santa Cruz-Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos 2790-134 Carnaxide, Portugal
| | - Muriel Sprynger
- Department of Cardiology-Angiology, University Hospital Liège, Liège, Belgium
| | - Marc Dweck
- British Heart Foundation, Centre for Cardiovascular Science, Edinburgh and Edinburgh Imaging Facility QMRI, University of Edinburgh, United Kingdom
| | - Thor Edvardsen
- Faculty of medicine, Oslo University, Oslo, Norway and Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Bogdan A Popescu
- Cardiology Department, University of Medicine and Pharmacy 'Carol Davila', Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Sos. Fundeni 258, sector 2, 022328 Bucharest, Romania
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Taylor CJ, Ordóñez-Mena JM, Jones NR, Roalfe AK, Myerson SG, Prendergast BD, Hobbs FR. Survival of people with valvular heart disease in a large, English community-based cohort study. Heart 2021; 107:1336-1343. [PMID: 34031157 PMCID: PMC8327406 DOI: 10.1136/heartjnl-2020-318823] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/26/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Valvular heart disease (VHD) is present in half the population aged >65 years but is usually mild and of uncertain importance. We investigated the association between VHD and its phenotypes with all-cause and cause-specific mortality. METHODS The OxVALVE (Oxford Valvular Heart Disease) population cohort study screened 4009 participants aged >65 years to establish the presence and severity of VHD. We linked data to a national mortality registry and undertook detailed outcome analysis. RESULTS Mortality data were available for 3511 participants, of whom 361 (10.3%) died (median 6.49 years follow-up). Most had some form of valve abnormality (n=2645, 70.2%). In adjusted analyses, neither mild VHD (prevalence 44.9%) nor clinically significant VHD (moderate or severe stenosis or regurgitation; 5.2%) was associated with increased all-cause mortality (HR 1.20, 95% CI 0.96 to 1.51 and HR 1.47, 95% CI 0.94 to 2.31, respectively). Conversely, advanced aortic sclerosis (prevalence 2.25%) and advanced mitral annular calcification (MAC, 1.31%) were associated with an increased risk of death (HR 2.05, 95% CI 1.28 to 3.30 and HR 2.51, 95% CI 1.41 to 4.49, respectively). Mortality was highest for people with both clinically significant VHD and advanced aortic sclerosis or MAC (HR 4.38, 95% CI 1.99 to 9.67). CONCLUSIONS Advanced aortic sclerosis or MAC is associated with a worse outcome, particularly for patients with significant VHD, but also in the absence of other VHD. Older patients with mild VHD can be reassured about their prognosis. The absence of an association between significant VHD and mortality may reflect its relatively low prevalence in our cohort.
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Affiliation(s)
- Clare J Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - José M Ordóñez-Mena
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nicholas R Jones
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Andrea K Roalfe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Saul G Myerson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - Fd Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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37
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Bing R, Dweck MR. Aortic valve and coronary 18F-sodium fluoride activity: a common cause? J Nucl Cardiol 2021; 28:1532-1535. [PMID: 31562577 DOI: 10.1007/s12350-019-01901-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 09/12/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Rong Bing
- BHF Centre for Cardiovascular Science, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
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Garg PK, Buzkova P, Meyghani Z, Budoff MJ, Lima J, Criqui M, Cushman M, Allison M. Valvular calcification and risk of peripheral artery disease: the Multi-Ethnic Study of Atherosclerosis (MESA). Eur Heart J Cardiovasc Imaging 2021; 21:1152-1159. [PMID: 31740939 DOI: 10.1093/ehjci/jez284] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/20/2019] [Accepted: 10/25/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS The detection of cardiac valvular calcification on routine imaging may provide an opportunity to identify individuals at increased risk for peripheral artery disease (PAD). We investigated the associations of aortic valvular calcification (AVC) and mitral annular calcification (MAC) with risk of developing clinical PAD or a low ankle-brachial index (ABI). METHODS AND RESULTS AVC and MAC were measured on cardiac computed tomography in 6778 Multi-Ethnic Study of Atherosclerosis participants without baseline PAD between 2000 and 2002. Clinical PAD was ascertained through 2015. Incident low ABI, defined as ABI <0.9 and decline of ≥0.15, was assessed among 5762 individuals who had an ABI >0.9 at baseline and at least one follow-up ABI measurement 3-10 years later. Adjusted Cox proportional hazards and Poisson regression modelling were used to determine the association of valvular calcification with clinical PAD and low ABI, respectively. There were 117 clinical PAD and 198 low ABI events that occurred over a median follow-up of 14 years and 9.2 years, respectively. The presence of MAC was associated with an increased risk of clinical PAD [hazard ratio 1.79; 95% confidence interval (CI) 1.04-3.05] but not a low ABI (rate ratio 1.28; 95% CI 0.75-2.19). No significant associations were noted for the presence of AVC and risk of either clinical PAD. CONCLUSION MAC is associated with an increased risk of developing clinical PAD. Future studies are needed to corroborate our findings and better understand whether MAC holds any predictive value as a risk marker for PAD.
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Affiliation(s)
- Parveen K Garg
- Division of Cardiology, University of Southern California Keck School of Medicine, 1510 San Pablo St. Suite 322, Los Angeles, CA, USA
| | - Petra Buzkova
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Zahra Meyghani
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Joao Lima
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Criqui
- Division of Preventive Medicine, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - Mary Cushman
- Department of Medicine and Pathology & Laboratory Medicine, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Matthew Allison
- Division of Preventive Medicine, University of California, San Diego School of Medicine, San Diego, CA, USA
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Reid A, Blanke P, Bax JJ, Leipsic J. Multimodality imaging in valvular heart disease: how to use state-of-the-art technology in daily practice. Eur Heart J 2021; 42:1912-1925. [PMID: 33186469 DOI: 10.1093/eurheartj/ehaa768] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/15/2020] [Accepted: 09/08/2020] [Indexed: 12/16/2022] Open
Abstract
Our understanding of the complexities of valvular heart disease (VHD) has evolved in recent years, primarily because of the increased use of multimodality imaging (MMI). Whilst echocardiography remains the primary imaging technique, the contemporary evaluation of patients with VHD requires comprehensive analysis of the mechanism of valvular dysfunction, accurate quantification of severity, and active exclusion extravalvular consequences. Furthermore, advances in surgical and percutaneous therapies have driven the need for meticulous multimodality imaging to aid in patient and procedural selection. Fundamental decision-making regarding whom, when, and how to treat patients with VHD has become more complex. There has been rapid technological advancement in MMI; many techniques are now available in routine clinical practice, and their integration into has the potential to truly individualize management strategies. This review provides an overview of the current evidence for the use of MMI in VHD, and how various techniques within each modality can be used practically to answer clinical conundrums.
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Affiliation(s)
- Anna Reid
- Department of Radiology and Cardiology, Center for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver V6Z1Y6, BC, Canada
| | - Philipp Blanke
- Department of Radiology and Cardiology, Center for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver V6Z1Y6, BC, Canada
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Jonathon Leipsic
- Department of Radiology and Cardiology, Center for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver V6Z1Y6, BC, Canada
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Pennell D, Delgado V, Knuuti J, Maurovich-Horvat P, Bax JJ. The year in cardiology: imaging. Eur Heart J 2021; 41:739-747. [PMID: 31901937 DOI: 10.1093/eurheartj/ehz930] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 11/28/2019] [Accepted: 12/11/2019] [Indexed: 12/31/2022] Open
Abstract
Abstract
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Affiliation(s)
- Dudley Pennell
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, UK
| | - Victoria Delgado
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Leiden, The Netherlands
| | - Juhani Knuuti
- Turku PET Centre, University of Turku, and Turku University Hospital, Turku, Finland
| | - Pàl Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Leiden, The Netherlands
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41
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Fletcher AJ, Dweck MR. Detecting native and bioprosthetic aortic valve disease using 18F-sodium fluoride: Clinical implications. J Nucl Cardiol 2021; 28:481-491. [PMID: 33175301 PMCID: PMC8076133 DOI: 10.1007/s12350-020-02411-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/26/2020] [Indexed: 01/17/2023]
Abstract
Calcific aortic valve disease is the most common valvular disease and confers significant morbidity and mortality. There are currently no medical therapies that successfully halt or reverse the disease progression, making surgical replacement the only treatment currently available. The majority of patients will receive a bioprosthetic valve, which themselves are prone to degeneration and may also need replaced, adding to the already substantial healthcare burden of aortic stenosis. Echocardiography and computed tomography can identify late-stage manifestations of the disease process affecting native and bioprosthetic aortic valves but cannot detect or quantify early molecular changes. 18F-fluoride positron emission tomography, on the other hand, can non-invasively and sensitively assess disease activity in the valves. The current review outlines the pivotal role this novel molecular imaging technique has played in improving our understanding of native and bioprosthetic aortic valve disease, as well as providing insights into its feasibility as an important future research and clinical tool.
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Affiliation(s)
- Alexander J Fletcher
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 49 Little France, Edinburgh, EH16 4TJ, UK.
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 49 Little France, Edinburgh, EH16 4TJ, UK
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42
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Williams MC, Massera D, Moss AJ, Bing R, Bularga A, Adamson PD, Hunter A, Alam S, Shah ASV, Pawade T, Roditi G, van Beek EJR, Nicol ED, Newby DE, Dweck MR. Prevalence and clinical implications of valvular calcification on coronary computed tomography angiography. Eur Heart J Cardiovasc Imaging 2021; 22:262-270. [PMID: 33306104 PMCID: PMC7899264 DOI: 10.1093/ehjci/jeaa263] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/07/2020] [Indexed: 12/11/2022] Open
Abstract
AIMS Valvular heart disease can be identified by calcification on coronary computed tomography angiography (CCTA) and has been associated with adverse clinical outcomes. We assessed aortic and mitral valve calcification in patients presenting with stable chest pain and their association with cardiovascular risk factors, coronary artery disease, and cardiovascular outcomes. METHODS AND RESULTS In 1769 patients (58 ± 9 years, 56% male) undergoing CCTA for stable chest pain, aortic and mitral valve calcification were quantified using Agatston score. Aortic valve calcification was present in 241 (14%) and mitral calcification in 64 (4%). Independent predictors of aortic valve calcification were age, male sex, hypertension, diabetes mellitus, and cerebrovascular disease, whereas the only predictor of mitral valve calcification was age. Patients with aortic and mitral valve calcification had higher coronary artery calcium scores and more obstructive coronary artery disease. The composite endpoint of cardiovascular mortality, non-fatal myocardial infarction, or non-fatal stroke was higher in those with aortic [hazard ratio (HR) 2.87; 95% confidence interval (CI) 1.60-5.17; P < 0.001] or mitral (HR 3.50; 95% CI 1.47-8.07; P = 0.004) valve calcification, but this was not independent of coronary artery calcification or obstructive coronary artery disease. CONCLUSION Aortic and mitral valve calcification occurs in one in six patients with stable chest pain undergoing CCTA and is associated with concomitant coronary atherosclerosis. Whilst valvular calcification is associated with a higher risk of cardiovascular events, this was not independent of the burden of coronary artery disease.
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Affiliation(s)
- Michelle C Williams
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh EH164TJ, UK
| | - Daniele Massera
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Alastair J Moss
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
| | - Rong Bing
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
| | - Anda Bularga
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
| | - Philip D Adamson
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
- Christchurch Heart Institute, University of Otago, Christchurch 8140, New Zealand
| | - Amanda Hunter
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
| | - Shirjel Alam
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
| | - Anoop S V Shah
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
| | - Tania Pawade
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
| | - Giles Roditi
- Glasgow Clinical Research Imaging Facility, Queen Elizabeth University Hospital, Glasgow G514LB, UK
| | - Edwin J R van Beek
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh EH164TJ, UK
| | | | - David E Newby
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh EH164TJ, UK
| | - Marc R Dweck
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh EH164TJ, UK
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Wiener PC, Darwish A, Friend E, Kadem L, Pressman GS. Energy loss associated with in-vitro modeling of mitral annular calcification. PLoS One 2021; 16:e0246701. [PMID: 33591991 PMCID: PMC7886214 DOI: 10.1371/journal.pone.0246701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/22/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Study aims were to compare hemodynamics and viscous energy dissipation (VED) in 3D printed mitral valves–one replicating a normal valve and the other a valve with severe mitral annular calcification (MAC). Patients with severe MAC develop transmitral gradients, without the commissural fusion typifying rheumatic mitral stenosis (MS), and may have symptoms similar to classical MS. A proposed mechanism relates to VED due to disturbed blood flow through the diseased valve into the ventricle. Methods A silicone model of a normal mitral valve (MV) was created using a transesophageal echocardiography dataset. 3D printed calcium phantoms were incorporated into a second valve model to replicate severe MAC. The synthetic MVs were tested in a left heart duplicator under rest and exercise conditions. Fine particles were suspended in a water/glycerol blood analogue for particle image velocimetry calculation of VED. Results Catheter mean transmitral gradients were slightly higher in the MAC valve compared to the normal MV, both at rest (3.2 vs. 1.3 mm Hg) and with exercise (5.9 vs. 5.0 mm Hg); Doppler gradients were 2.7 vs. 2.1 mm Hg at rest and 9.9 vs 8.2 mm Hg with exercise. VED was similar between the two valves at rest. During exercise, VED increased to a greater extent for the MAC valve (240%) versus the normal valve (127%). Conclusion MAC MS is associated with slightly increased transmitral gradients but markedly increased VED during exercise. These energy losses may contribute to the exercise intolerance and exertional dyspnea present in MAC patients.
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Affiliation(s)
- Philip C. Wiener
- Division of Cardiology, Heart and Vascular Institute, Einstein Medical Center, Philadelphia, PA, United States of America
| | - Ahmed Darwish
- Department of Mechanical, Industrial and Aerospace Engineering, Concordia University, Montreal, Canada
| | - Evan Friend
- Division of Cardiology, Heart and Vascular Institute, Einstein Medical Center, Philadelphia, PA, United States of America
| | - Lyes Kadem
- Department of Mechanical, Industrial and Aerospace Engineering, Concordia University, Montreal, Canada
| | - Gregg S. Pressman
- Division of Cardiology, Heart and Vascular Institute, Einstein Medical Center, Philadelphia, PA, United States of America
- * E-mail:
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Advances in Quantitative Analysis of 18F-Sodium Fluoride Coronary Imaging. Mol Imaging 2021; 2021:8849429. [PMID: 33746631 PMCID: PMC7953548 DOI: 10.1155/2021/8849429] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/05/2020] [Indexed: 11/22/2022] Open
Abstract
18F-sodium fluoride (18F-NaF) positron emission tomography (PET) has emerged as a promising noninvasive imaging tool for the assessment of active calcification processes in coronary artery disease. 18F-NaF uptake colocalizes to high-risk and ruptured atherosclerotic plaques. Most recently, 18F-NaF coronary uptake was shown to be a robust and independent predictor of myocardial infarction in patients with advanced coronary artery disease. In this review, we provide an overview of the advances in coronary 18F-NaF imaging. In particular, we discuss the recently developed and validated motion correction techniques which address heart contractions, tidal breathing, and patient repositioning during the prolonged PET acquisitions. Additionally, we discuss a novel quantification approach—the coronary microcalcification activity (which has been inspired by the widely employed method in oncology total active tumor volume measurement). This new method provides a single number encompassing 18F-NaF activity within the entire coronary vasculature rather than just information regarding a single area of most intense tracer uptake.
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45
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Urena M, Vahanian A, Brochet E, Ducrocq G, Iung B, Himbert D. Current Indications for Transcatheter Mitral Valve Replacement Using Transcatheter Aortic Valves. Circulation 2021; 143:178-196. [DOI: 10.1161/circulationaha.120.048147] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Use of transcatheter mitral valve replacement (TMVR) using transcatheter aortic valves in clinical practice is limited to patients with failing bioprostheses and rings or mitral valve disease associated with severe mitral annulus calcification. Whereas the use of valve-in-valve TMVR appears to be a reasonable alternative to surgery in patients at high surgical risk, much less evidence supports valve-in-ring and valve-in-mitral annulus calcification interventions. Data on the results of TMVR in these settings are derived from small case series or voluntary registries. This review summarizes the current evidence on TMVR using transcatheter aortic valves in clinical practice from the characteristics of the TMVR candidates, screening process, performance of the procedure, and description of current results and future perspectives. TMVR using dedicated devices in native noncalcified mitral valve diseases is beyond the scope of the article.
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Affiliation(s)
- Marina Urena
- University of Paris, France (M.U., A.V., G.D., B.I.)
- Assistance Publique, Hôpitaux de Paris, Department of Cardiology, Bichat Claude Bernard Hospital, France (M.U., E.B., G.D., B.I., D.H.)
| | - Alec Vahanian
- University of Paris, France (M.U., A.V., G.D., B.I.)
| | - Eric Brochet
- University of Paris, France (M.U., A.V., G.D., B.I.)
| | - Gregory Ducrocq
- University of Paris, France (M.U., A.V., G.D., B.I.)
- Assistance Publique, Hôpitaux de Paris, Department of Cardiology, Bichat Claude Bernard Hospital, France (M.U., E.B., G.D., B.I., D.H.)
| | - Bernard Iung
- University of Paris, France (M.U., A.V., G.D., B.I.)
- Assistance Publique, Hôpitaux de Paris, Department of Cardiology, Bichat Claude Bernard Hospital, France (M.U., E.B., G.D., B.I., D.H.)
| | - Dominique Himbert
- Assistance Publique, Hôpitaux de Paris, Department of Cardiology, Bichat Claude Bernard Hospital, France (M.U., E.B., G.D., B.I., D.H.)
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Birkhoelzer SM, Thamman R. Caseous Mitral Annulus Calcification: A Rare Complication of a Common Disease That Needs Recognition. JACC Case Rep 2021; 3:109-111. [PMID: 34317480 PMCID: PMC8305683 DOI: 10.1016/j.jaccas.2020.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sarah M. Birkhoelzer
- Department of Cardiology, Portsmouth Hospitals University National Health Service Trust, Portsmouth, United Kingdom
| | - Ritu Thamman
- Department, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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47
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Doris MK, Meah MN, Moss AJ, Andrews JPM, Bing R, Gillen R, Weir N, Syed M, Daghem M, Shah A, Williams MC, van Beek EJR, Forsyth L, Dey D, Slomka PJ, Dweck MR, Newby DE, Adamson PD. Coronary 18F-Fluoride Uptake and Progression of Coronary Artery Calcification. Circ Cardiovasc Imaging 2020; 13:e011438. [PMID: 33297761 PMCID: PMC7771641 DOI: 10.1161/circimaging.120.011438] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Supplemental Digital Content is available in the text. Background Positron emission tomography (PET) using 18F-sodium fluoride (18F-fluoride) to detect microcalcification may provide insight into disease activity in coronary atherosclerosis. This study aimed to investigate the relationship between 18F-fluoride uptake and progression of coronary calcification in patients with clinically stable coronary artery disease. Methods Patients with established multivessel coronary atherosclerosis underwent 18F-fluoride PET-computed tomography angiography and computed tomography calcium scoring, with repeat computed tomography angiography and calcium scoring at one year. Coronary PET uptake was analyzed qualitatively and semiquantitatively in diseased vessels by measuring maximum tissue-to-background ratio. Coronary calcification was quantified by measuring calcium score, mass, and volume. Results In a total of 183 participants (median age 66 years, 80% male), 116 (63%) patients had increased 18F-fluoride uptake in at least one vessel. Individuals with increased 18F-fluoride uptake demonstrated more rapid progression of calcification compared with those without uptake (change in calcium score, 97 [39–166] versus 35 [7–93] AU; P<0.0001). Indeed, the calcium score only increased in coronary segments with 18F-fluoride uptake (from 95 [30–209] to 148 [61–289] AU; P<0.001) and remained unchanged in segments without 18F-fluoride uptake (from 46 [16–113] to 49 [20–115] AU; P=0.329). Baseline coronary 18F-fluoride maximum tissue-to-background ratio correlated with 1-year change in calcium score, calcium volume, and calcium mass (Spearman ρ=0.37, 0.38, and 0.46, respectively; P<0.0001 for all). At the segmental level, baseline 18F-fluoride activity was an independent predictor of calcium score at 12 months (P<0.001). However, at the patient level, this was not independent of age, sex, and baseline calcium score (P=0.50). Conclusions Coronary 18F-fluoride uptake identifies both patients and individual coronary segments with more rapid progression of coronary calcification, providing important insights into disease activity within the coronary circulation. At the individual patient level, total calcium score remains an important marker of disease burden and progression. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02110303.
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Affiliation(s)
- Mhairi K Doris
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom
| | - Mohammed N Meah
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom
| | - Alastair J Moss
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom
| | - Jack P M Andrews
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom
| | - Rong Bing
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom
| | - Rebecca Gillen
- Edinburgh Imaging, Queen's Medical Research Institute University of Edinburgh, Edinburgh, United Kingdom (Rebecca Gillen, Nick Weir, Michelle C Williams, Edwin JR van Beek, David E Newby)
| | - Nick Weir
- Edinburgh Imaging, Queen's Medical Research Institute University of Edinburgh, Edinburgh, United Kingdom (Rebecca Gillen, Nick Weir, Michelle C Williams, Edwin JR van Beek, David E Newby)
| | - Maaz Syed
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom
| | - Marwa Daghem
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom
| | - Anoop Shah
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom
| | - Michelle C Williams
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom.,Edinburgh Imaging, Queen's Medical Research Institute University of Edinburgh, Edinburgh, United Kingdom (Rebecca Gillen, Nick Weir, Michelle C Williams, Edwin JR van Beek, David E Newby)
| | - Edwin J R van Beek
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom.,Edinburgh Imaging, Queen's Medical Research Institute University of Edinburgh, Edinburgh, United Kingdom (Rebecca Gillen, Nick Weir, Michelle C Williams, Edwin JR van Beek, David E Newby)
| | - Laura Forsyth
- Edinburgh Clinical Trials Unit (L.F.), University of Edinburgh, United Kingdom
| | - Damini Dey
- Division of Nuclear Medicine, Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA (D.D., P.J.S.)
| | - Piotr J Slomka
- Division of Nuclear Medicine, Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA (D.D., P.J.S.)
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom.,Edinburgh Imaging, Queen's Medical Research Institute University of Edinburgh, Edinburgh, United Kingdom (Rebecca Gillen, Nick Weir, Michelle C Williams, Edwin JR van Beek, David E Newby)
| | - Philip D Adamson
- British Heart Foundation Centre for Cardiovascular Science (M.K.D., M.N.M., A.J.M., J.P.M.A., R.B., M.S., M.D., A.S., M.C.W., E.J.R.v.B., M.R.D., D.E.N., P.D.A.), University of Edinburgh, United Kingdom.,Christchurch Heart Institute, University of Otago, Christchurch, NZ (P.D.A.)
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48
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Lopez Avecilla M, Corneli M, Killinger G, Rodriguez Correa C. Case report: Metastatic cardiac calcifications in a patient with a history of rickets. Eur Heart J Case Rep 2020; 4:1-5. [PMID: 33629002 PMCID: PMC7891257 DOI: 10.1093/ehjcr/ytaa283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/14/2020] [Accepted: 07/29/2020] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Metastatic cardiac calcifications are often seen in patients with renal failure and dialysis associated with vascular calcification and calcifications in other organs. There is little to no evidence of metastatic cardiac calcification in patients with a history of rickets.
Case summary
A 40-year-old patient with a history of rickets treated in infancy and no personal history of cardiovascular or renal disease came for a periodical examination. Transthoracic echocardiogram showed an important calcification in the mitral annulus and the mitro-aortic junction. Computed tomography (CT) showed marked calcification affecting the heart fibrous skeleton. Coronary arteries were not affected.
Discussion
Distribution of heart calcification seen both with echocardiography and CT is important to report so they can be identified as dystrophic or metastatic. These two have different aetiologies so the description may help identify the possible cause.
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Affiliation(s)
- Matias Lopez Avecilla
- Departamento de Diagnóstico por Imágenes en Cardiología, Centro Diagnóstico Dr Enrique Rossi, Buenos Aires, Argentina
| | - Mariana Corneli
- Departamento de Diagnóstico por Imágenes en Cardiología, Centro Diagnóstico Dr Enrique Rossi, Buenos Aires, Argentina
| | - Gisela Killinger
- Departamento de Diagnóstico por Imágenes en Cardiología, Centro Diagnóstico Dr Enrique Rossi, Buenos Aires, Argentina
| | - Carlos Rodriguez Correa
- Departamento de Diagnóstico por Imágenes en Cardiología, Centro Diagnóstico Dr Enrique Rossi, Buenos Aires, Argentina
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49
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Affiliation(s)
- Rebecca T Hahn
- Columbia University Medical Center, NY Presbyterian Hospital, New York, NY, USA
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50
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Forman DE, de Lemos JA, Shaw LJ, Reuben DB, Lyubarova R, Peterson ED, Spertus JA, Zieman S, Salive ME, Rich MW. Cardiovascular Biomarkers and Imaging in Older Adults: JACC Council Perspectives. J Am Coll Cardiol 2020; 76:1577-1594. [PMID: 32972536 PMCID: PMC7540920 DOI: 10.1016/j.jacc.2020.07.055] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 01/13/2023]
Abstract
Whereas the burgeoning population of older adults is intrinsically vulnerable to cardiovascular disease, the utility of many management precepts that were validated in younger adults is often unclear. Whereas biomarker- and imaging-based tests are a major part of cardiovascular disease care, basic assumptions about their use and efficacy cannot be simply extrapolated to many older adults. Biology, physiology, and body composition change with aging, with important influences on cardiovascular disease testing procedures and their interpretation. Furthermore, clinical priorities of older adults are more heterogeneous, potentially undercutting the utility of testing data that are collected. The American College of Cardiology and the National Institutes on Aging, in collaboration with the American Geriatrics Society, convened, at the American College of Cardiology Heart House, a 2-day multidisciplinary workshop, "Diagnostic Testing in Older Adults with Cardiovascular Disease," to address these issues. This review summarizes key concepts, clinical limitations, and important opportunities for research.
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Affiliation(s)
- Daniel E Forman
- Section of Geriatric Cardiology, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania; Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
| | - James A de Lemos
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Leslee J Shaw
- Department of Medicine and Radiology, Weill Cornell Medical College, New York, New York
| | - David B Reuben
- Division of Geriatrics, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California
| | - Radmila Lyubarova
- Division of Cardiology, Department of Medicine, Albany Medical College, Albany, New York
| | | | - John A Spertus
- Saint Luke's Mid America Heart Institute, the University of Missouri-Kansas City, Kansas City, Missouri
| | - Susan Zieman
- Division of Geriatrics and Clinical Gerontology, National Institute on Aging, Bethesda, Maryland
| | - Marcel E Salive
- Division of Geriatrics and Clinical Gerontology, National Institute on Aging, Bethesda, Maryland
| | - Michael W Rich
- Washington University School of Medicine, St. Louis, Missouri
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