title: Mitral annular calcification: a marker of severe coronary artery disease in patients under 65 years old.
abstract: 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 <or= 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 >or= 70% stenosis of at least one major epicardial coronary artery.
  
  
  METHODS
  17 735 patients were screened. Of these, 6207 (35%) had mitral annular calcification and 885 (5%) were also <or= 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 <or= 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.
authors.affiliation: Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
authors.forename: S
authors.initials: S
authors.lastname: Atar
authors.forename: D S
authors.initials: DS
authors.lastname: Jeon
authors.forename: H
authors.initials: H
authors.lastname: Luo
authors.forename: R J
authors.initials: RJ
authors.lastname: Siegel
mesh_terms: D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000473:pathology*; D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000473:pathology*; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000473:pathology; D023921:Coronary Stenosis / Q000473:pathology*; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D015999:Multivariate Analysis; D011446:Prospective Studies; D012737:Sex Factors; D014463:Ultrasonography