title: Calcification of the mitral valve and annulus: systematic evaluation of effects on valve anatomy and function.
abstract: BACKGROUND
  Mitral annular calcification (MAC) is common in chronic kidney disease. It is associated with cardiovascular events and can cause valvular dysfunction, but it has not been systematically characterized. The aim of this prospective study was to assess the prevalence and distribution of MAC, its effects on leaflet motion, and its association with mitral stenosis and mitral regurgitation (MR) in a hemodialysis population.
  
  
  METHODS
  Echocardiograms were obtained in 75 consecutive hemodialysis outpatients. MAC extent and distribution were graded semiquantitatively using two-dimensional and three-dimensional echocardiography. Associations with the presence and severity of mitral stenosis and MR were explored.
  
  
  RESULTS
  The mean age was 60 ± 14 years; 60% were men, and 87% were African American. MAC was present in 64% (moderate to severe in 48%). Calcium extended more than halfway onto the leaflet in 37% and beyond the annulus in 40%. Leaflet motion was restricted in 37%. Mitral stenosis was present in 28%, and the extent of calcification was associated with mean mitral valve gradient (P < .0001). MR was prevalent (present in 81%) but was severe in none. The severity of MAC was greater in patients with moderate MR than in those with no or mild MR (P = .04). Three-dimensional analysis suggested an uneven distribution of annular calcium; the middle and lateral anterior segments were less often calcified than the anterior-medial or posterior segments. Calcification in any annular segment was highly associated with restricted motion of the attached leaflet segment.
  
  
  CONCLUSIONS
  MAC is common and often extensive in hemodialysis patients. Calcium may be unevenly distributed among the annular segments. When present, annular calcification reduces the angle of leaflet opening and can cause valvular dysfunction.
authors.affiliation: Division of Cardiology (R.M., K.M., A.R.-C., H.R.S.R., G.S.P.) and the Division of Nephrology (P.F.), Einstein Medical Center, Philadelphia, Pennsylvania.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Movva
authors.affiliation: Division of Cardiology (R.M., K.M., A.R.-C., H.R.S.R., G.S.P.) and the Division of Nephrology (P.F.), Einstein Medical Center, Philadelphia, Pennsylvania.
authors.forename: Kinnari
authors.initials: K
authors.lastname: Murthy
authors.affiliation: Division of Cardiology (R.M., K.M., A.R.-C., H.R.S.R., G.S.P.) and the Division of Nephrology (P.F.), Einstein Medical Center, Philadelphia, Pennsylvania.
authors.forename: Abel
authors.initials: A
authors.lastname: Romero-Corral
authors.affiliation: Division of Cardiology (R.M., K.M., A.R.-C., H.R.S.R., G.S.P.) and the Division of Nephrology (P.F.), Einstein Medical Center, Philadelphia, Pennsylvania.
authors.forename: Harish Raj
authors.initials: HR
authors.lastname: Seetha Rammohan
authors.affiliation: Division of Cardiology (R.M., K.M., A.R.-C., H.R.S.R., G.S.P.) and the Division of Nephrology (P.F.), Einstein Medical Center, Philadelphia, Pennsylvania.
authors.forename: Peter
authors.initials: P
authors.lastname: Fumo
authors.affiliation: Division of Cardiology (R.M., K.M., A.R.-C., H.R.S.R., G.S.P.) and the Division of Nephrology (P.F.), Einstein Medical Center, Philadelphia, Pennsylvania. Electronic address: pressmang@einstein.edu.
authors.forename: Gregg S
authors.initials: GS
authors.lastname: Pressman
mesh_terms: D000368:Aged; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D015150:Echocardiography, Doppler; D005260:Female; D006349:Heart Valve Diseases / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000503:physiopathology; D008944:Mitral Valve Insufficiency / Q000453:epidemiology / Q000473:pathology; D015999:Multivariate Analysis; D011446:Prospective Studies
keywords: Hemodialysis; MAC; MR; MS; Mitral annular calcification; Mitral regurgitation; Mitral stenosis