title: Mitral annular calcification predicts mortality and coronary artery disease in end stage renal disease.
abstract: BACKGROUND
  We sought to determine whether mitral annular calcification (MAC) predicts mortality and cardiac disease in a group of renal transplant candidates.
  
  
  METHODS
  Hundred and forty patients were prospectively studied. All had echocardiography and coronary angiography. Significant coronary artery disease (CAD) was defined as luminal stenosis >70% by visual estimation in at least one coronary artery.
  
  
  RESULTS
  There were 21 deaths over a follow-up period of 2.2+/-0.7 years. MAC occurred in 56 patients (40%) and was associated with higher mortality (p=0.04). Patients with MAC were older (p=or<0.001), had larger left ventricular (LV) end systolic (p=0.005) and LV end diastolic (p=0.04) diameter, larger left atrial diameter (p=0.001), lower LV fractional shortening (p=0.003), larger LV mass index (p=0.04) and higher mitral E/Ea ratio (p=0.03) compared to those without. Plasma calcium (p=0.002), phosphate (p=0.004), cardiac troponin T (p=0.03), N-terminal Pro-B-type natriuretic peptide (p=0.004) concentrations were higher in those with MAC but gender, total cholesterol, haemoglobin and creatinine were similar in the two groups. The proportion diabetic (p=0.03), on dialysis (p=0.05), with significant CAD (p=or<0.001), taking calcium containing phosphate binders (p=0.02) and Vitamin D3 (p=0.04) was significantly higher in those with MAC. Significant CAD (OR 12, 95% CI 3.25, p=0.001) was the only independent associate of MAC.
  
  
  CONCLUSIONS
  MAC is associated with increased mortality and significant CAD in ESRD. These patients have increased LV cavity size, poorer LV systolic function, higher LV filling pressures compared to patients without MAC.
authors.affiliation: Department of Cardiology, St George's Hospital, London, United Kingdom. rajdoc.Sharma@tiscali.co.uk
authors.forename: Rajan
authors.initials: R
authors.lastname: Sharma
authors.forename: Denis
authors.initials: D
authors.lastname: Pellerin
authors.forename: David C
authors.initials: DC
authors.lastname: Gaze
authors.forename: Rajnikant L
authors.initials: RL
authors.lastname: Mehta
authors.forename: Helen
authors.initials: H
authors.lastname: Gregson
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Streather
authors.forename: Paul O
authors.initials: PO
authors.lastname: Collinson
authors.forename: Stephen J D
authors.initials: SJ
authors.lastname: Brecker
mesh_terms: D000328:Adult; D002114:Calcinosis / Q000150:complications* / Q000209:etiology / Q000401:mortality / Q000473:pathology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000150:complications* / Q000209:etiology / Q000401:mortality / Q000473:pathology; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality* / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology; D016277:Ventricular Function, Left