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(Stroke. 1999;30:693.)
© 1999 American Heart Association, Inc.

Letters to the Editor

Mitral Annulus Calcification and Carotid Atherosclerotic Disease

Arthur Boon, MD, PhD

Department of Neurology, St. Anna Hospital, Geldrop, the Netherlands

Jan Lodder, MD, PhD

Department of Neurology

Emile Cheriex, MD, PhD

Department of Cardiology, University Hospital, Maastricht, the Netherlands

Fons Kessels, MD

Department of Epidemiology, University of Limburg, Maastricht, the Netherlands

To the Editor:

In their interesting study, Adler et al¹ reported a significantly higher prevalence of carotid stenosis of 40% in patients with mitral annulus calcification (MAC) compared with controls. They also stated that whether MAC is a marker or a direct cause of stroke is still unknown.

However, a recently published prospective cohort study² on the risk of stroke in MAC, with a follow-up ranging from 1 to 6.6 years, showed that the absolute stroke risk was increased in MAC but also that MAC was not an independent risk factor for stroke (HR, 0.76; 95% CI, 0.42 to 1.36). On the other hand, there was a strong independent association of stroke with any carotid stenosis and established risk factors for vascular disease, as expected. These findings suggest that MAC is a marker of generalised vascular disease and not a cause of stroke.

A recently published study³ on 657 patients with MAC and 815 with calcified aortic valve reported strong independent associations of these valve lesions with atherosclerotic risk factors. Although carotid investigation was not relevant in that study, this is a more direct evidence that MAC (and cardiac valve calcification in general^{3 4} ) should be considered as atherosclerotic comorbidity in stroke and not its cause.

References

1. Adler Y, Koren A, Fink N, Tanne D, Fusman R, Assali A, Yahav J, Zelikovski A, Sagie A. Association between mitral annulus calcification and carotid atherosclerotic disease. Stroke. 1998;29:1833–1837.[Abstract/Free Full Text]

2. Boon A, Lodder J, Cheriex E, Kessels F. Mitral annulus calcification is not an independent risk factor for stroke: a cohort study of 657 patients. J Neurol. 1997;244:535–541.[Medline] [Order article via Infotrieve]

3. Boon A, Cheriex E, Lodder J, Kessels F. Cardiac valve calcification: characteristics of patients with calcification of the mitral annulus or aortic valve. Heart. 1997;78:472–474.[Abstract/Free Full Text]

4. Boon A, Lodder J, Cheriex E, Kessels F. Risk of stroke in a cohort of 815 patients with calcification of the aortic valve with or without stenosis. Stroke. 1996;27:847–851.[Abstract/Free Full Text]

Response

Yehuda Adler, MD; David Tanne, MD Alex Sagie, MD

Department of Cardiology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel

Key Words: carotid artery diseases • mitral annulus calcification

We are delighted with the interest shown by Dr Boon and colleagues in our study on the association between mitral valve calcification and carotid atherosclerotic disease,¹ and we thank them for their insightful comments. Our group has been studying this issue of valve calcification and generalized vascular atherosclerotic disease for several years. In addition to carotid atherosclerotic disease, we have documented with a high association of mitral annulus calcification with aortic atheroma² and coronary atherosclerotic disease.³

The important work by Boon et al^{4 5 6} adds significant data with which we fully agree. This mounting evidence suggests that mitral annulus calcification should likely be considered, in most cases, as an atherosclerotic comorbidity in stroke, and not its cause.

We are currently completing several prospective studies strengthening the hypothesis that mitral annulus calcification is an atherosclerotic process which may be a marker for generalized atherosclerotic vascular disease.

References

1. Adler Y, Koren A, Fink N, Tanne D, Fusman R, Assali A, Yahav J., Zelikovski A, Sagie A. Association between mitral annulus calcification and carotid atherosclerotic disease. Stroke. 1998;29:1833–1837.

2. Adler Y, Zabarski RS, Vaturi M, Shapira Y, Ehrlich S, Jortner R, Assali A, Zonshin A, Sagie A. Association between mitral annulus calcium and aortic atheroma as detected by transesophageal echocardiographic study. Am J Cardiol. 1998;81:784–786.[Medline] [Order article via Infotrieve]

3. Adler Y, Herz J, Vaturi M, Fusman R, Zabarski RS, Fink N, Porter A, Shapira A, Assali A, Sagie A. Mitral annular calcium detected by transthoracic echocardiography is a marker for high prevalence and severity of coronary artery disease in patients undergoing coronary angiography. Am J Cardiol. 1998;82:1183–1186.[Medline] [Order article via Infotrieve]

4. Boon A, Lodder J, Cheriex E, Kessels F. Mitral annulus calcification is not an independent risk factor for stroke: a cohort study of 657 patients. J Neurol. 1997;244:535–541.

5. Boon A, Cheriex E, Lodder J, Kessels F, Cardiac valve calcification; characteristics of patients with calcification of the mitral annulus or aortic valve. Heart. 1997;78:472–474.

6. Boon A, Loder J, Cheriex E, Kessels F. Risk of stroke in a cohort of 815 patients with calcification of the aortic valve with or without stenosis. Stroke. 1996;27:847–851.

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Boon, A. Articles by Sagie, A. Search for Related Content PubMed PubMed Citation Articles by Boon, A. Articles by Sagie, A. Related Collections Valvular heart disease Carotid Stenosis Cerebral Aneurysm, AVM, & Subarachnoid hemorrhage Rehabilitation, Stroke Antiplatelets Other Stroke Treatment - Medical