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Mitral annular calcification: a marker of severe coronary artery disease in patients under 65 years old
  1. S Atar,
  2. D S Jeon,
  3. H Luo,
  4. R J Siegel
  1. Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
  1. Correspondence to:
    Dr Robert J Siegel, Cardiac Non-invasive Laboratory, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA;


Background: Mitral annular calcification has been associated with various systemic and cardiac diseases, with a higher prevalence in women and patients over 70. A possible association between mitral annular calcification and coronary artery disease has recently been suggested.

Objective: To determine the prevalence of severe coronary artery disease in younger patients with mitral annular calcification.

Methods: Consecutive patients aged ≤ 65 years with and without mitral annular calcification as detected by echocardiography were identified from a prospective clinical database. Only patients with a coronary angiogram done within one year of their qualifying echocardiogram were analysed. Severe coronary artery disease was defined as ≥ 70% stenosis of at least one major epicardial coronary artery.

Patients: 17 735 patients were screened. Of these, 6207 (35%) had mitral annular calcification and 885 (5%) were also ≤ 65 years old; coronary angiography was done in 100 of the latter (64 men; 36 women), mainly for anginal symptoms or a positive stress test. A control group (n = 121; 88 men, 33 women) was identified from 2840 consecutive patients screened. There was no significant difference between the groups in patient characteristics, indication for angiography, or atherosclerotic risk factors.

Results: Angiography showed a higher prevalence of severe coronary artery disease in patients with mitral annular calcification than in those without (88% v 68%, p = 0.0004), and a higher prevalence of left main coronary artery disease (14% v 4%, p = 0.009) and triple vessel disease (54% v 33%, p = 0.002). The positive predictive value of mitral annular calcification for finding severe coronary artery disease was 92%.

Conclusions: In patients aged ≤ 65 years, mitral annular calcification is associated with an increased prevalence of severe obstructive coronary artery disease. It may serve as a useful echocardiographic marker for the presence of obstructive coronary artery disease, especially when associated with anginal symptoms.

  • mitral annular calcification
  • coronary angiography
  • echocardiography

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