title: Effect of Mitral Annular Calcium on Left Ventricular Diastolic Parameters.
abstract: Assessment of left ventricular (LV) diastolic function by Doppler flow imaging and tissue Doppler is an integral part of the echocardiographic examination. Mitral annular calcium (MAC) is frequently encountered on echocardiography. The aim of this study was to assess the impact of MAC, quantitatively measured by computed tomography scan, on echocardiographic LV diastolic parameters. We included 155 patients aged ≥65 years. Computed tomography reconstructions of the mitral annulus were created, and calcium identified and quantified by Agatston technique. Calcium locations were assigned using an overlaid template depicting the annular segments in relation to surrounding anatomic structures. Echocardiographic assessment of diastolic function was performed in standard fashion. Mean age was 77 years; 49% were men; and 43% were black. Patients with MAC had lower septal e' (p = 0.003), lateral e' (p = 0.04), and average e' (p = 0.01) compared with those without MAC. They also had a higher E-wave velocity (p = 0.01) and E/e' ratio (p <0.001). When evaluated by severity of MAC, and after adjustment for multiple clinical factors, there was a graded (inverse) relation between MAC severity and septal e' (p = 0.01), lateral e' (p = 0.01), and average e' (p = 0.01). In conclusion, LV diastolic parameters, as measured by Doppler echocardiography, are altered in the presence of MAC. This could be due to direct effects of MAC on annular function or might reflect truly reduced diastolic function. Interpretation of diastolic parameters in patients with MAC should be performed with caution.
authors.affiliation: Division of Cardiology, Department of Medicine, The Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, Pennsylvania.
authors.forename: Jose N
authors.initials: JN
authors.lastname: Codolosa
authors.affiliation: Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania.
authors.forename: Nikoloz
authors.initials: N
authors.lastname: Koshkelashvili
authors.affiliation: Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania.
authors.forename: Talal
authors.initials: T
authors.lastname: Alnabelsi
authors.affiliation: Department of Radiology, Einstein Medical Center, Philadelphia, Pennsylvania.
authors.forename: Igor
authors.initials: I
authors.lastname: Goykhman
authors.affiliation: Division of Cardiology, Department of Medicine, The Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, Pennsylvania.
authors.forename: Abel
authors.initials: A
authors.lastname: Romero-Corral
authors.affiliation: Division of Cardiology, Department of Medicine, The Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, Pennsylvania. Electronic address: pressmang@einstein.edu.
authors.forename: Gregg S
authors.initials: GS
authors.lastname: Pressman
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity; D002114:Calcinosis / Q000175:diagnosis / Q000503:physiopathology*; D009202:Cardiomyopathies / Q000175:diagnosis / Q000503:physiopathology*; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D008943:Mitral Valve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016277:Ventricular Function, Left / Q000502:physiology*