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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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Kipourou K, O’Driscoll JM, Sharma R. Valvular Heart Disease in Patients with Chronic Kidney Disease. Eur Cardiol 2022; 17:e02. [PMID: 35154392 PMCID: PMC8819604 DOI: 10.15420/ecr.2021.25] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/19/2021] [Indexed: 11/06/2022] Open
Abstract
Valvular heart disease (VHD) is highly prevalent in patients with chronic kidney disease (CKD) from the early stages to end-stage renal disease (ESRD). Aortic and mitral valves are the most frequently affected, leading to aortic valve and/or mitral annular calcification, which, in turn, causes either valve stenosis or regurgitation at an accelerated rate compared with the general population. Tricuspid regurgitation is also prevalent in CKD and ESRD, and haemodialysis patients are at an increasingly high risk of infective endocarditis. As for pathophysiology, several mechanisms causing VHD in CKD have been proposed, highlighting the complexity of the process. Echocardiography constitutes the gold standard for the assessment of VHD in CKD/ESRD patients, despite the progress of other imaging modalities. With regard to treatment, the existing 2017 European Society of Cardiology/European Association for Cardio-Thoracic Surgery guidelines on the management of VHD addressing patients with normal kidney function are also applied to patients with CKD/ESRD.
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Affiliation(s)
- Konstantina Kipourou
- Department of Cardiology, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Jamie M O’Driscoll
- Department of Cardiology, St George’s University Hospitals NHS Foundation Trust, London, UK; School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, UK
| | - Rajan Sharma
- Department of Cardiology, St George’s University Hospitals NHS Foundation Trust, London, UK; School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, UK
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