Abstract 3577: Thickness of mitral annular calcification is directly associated with cardiovascular morbidity and mortality. The Northern Manhattan Study.
BACKGROUND: Mitral annular calcification (MAC) is common in the elderly, and is associated with atherosclerotic risk factors. We sought to determine the magnitude of association between MAC and vascular events in the multiethnic prospective cohort of northern Manhattan.
METHODS: MAC was assessed by transthoracic 2D-echocardiography as binary (yes/no) and continuous (mm) variable. Subjects were aged ≥40 years at enrollment, and were free of prior myocardial infarction (MI) and stroke. The association between MAC and MI, ischemic stroke, and vascular death was examined, adjusting for established cardiovascular risk factors and for carotid artery stenosis (>60%) by means of Cox regression analysis.
RESULTS: Of 1,958 subjects, 502 (25.7%) had MAC. MAC was significantly associated with age, systolic blood pressure, male gender and history of atrial fibrillation. During a mean follow-up of 7.4 ± 2.5 months, there were 100 MI, 104 ischemic stroke and 156 vascular deaths recorded. After adjustment for other risk factors, MAC was associated with an increased risk of MI (HR 1.72, 95%CI 1.13–2.63; p=0.012) and vascular death (HR 1.57, 95%CI 1.12–2.20; p=0.008), but not of ischemic stroke (HR 1.36, 95%CI 0.89 –2.06; p=0.16). When MAC was categorized into mild to moderate (1– 4mm, n=253; 13.1%) or severe (≥4mm, n=245; 12.7%), severe MAC remained as a strong and independent predictor of vascular events, but not stroke (Table⇓).
CONCLUSION: MAC was a strong and independent predictor for MI and vascular death in this multiethnic cohort especially when its thickness is more than 4mm. Its predictive value for ischemic stroke was not independent of other cardiovascular risk factors.