rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2011-7-6-690-697rpcardio-958Research ArticleORIGINAL STUDIESОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯMITRAL ANNULAR CALCIFICATION IN ELDERLY PATIENTS. CLINICAL AND ECHOCARDIOGRAPHIC CHARACTERISTICSКАЛЬЦИНОЗ КОЛЬЦА МИТРАЛЬНОГО КЛАПАНА У ПОЖИЛЫХ БОЛЬНЫХ. КЛИНИКО-ЭХОКАРДИОГРАФИЧЕСКАЯ ХАРАКТЕРИСТИКАЧипигинаН. С.ChipiginaN. S.

к.м.н., доцент кафедры факультетской терапии

Chipigina-Natalia56@yandex.ruУрвачеваГ. М.UrvachevaG. M.

зав. поликлиническим отделением

ШостакН. А.ShostakN. A.

д.м.н., профессор, зав. кафедрой факультетской терапии

ЖитареваИ. В.ZhitarevaI. V.

к.м.н., доцент кафедры медицинской кибернетики и информатики

ЖитомирскаяИ. Ю.ZhitomirskayaI. Yu.

врач функциональной диагностики

Российский национальный исследовательский медицинский университет им. Н.И. ПироговаРоссияRussian National Research Medical University named after NI PirogovRussian FederationЦентр Диагностики и Реабилитации, филиал «Газпром трансгаз Москва»РоссияCenter of Diagnostic and Rehabilitation, Branch of “Gazprom Transgaz Moscow"Russian FederationГородская поликлиника №141РоссияMunicipal outpatient clinic N141Russian Federation20112101201676690697Copyright © Chipigina N.S., Urvacheva G.M., Shostak N.A., Zhitareva I.V., Zhitomirskaya I.Y., 20162016Чипигина Н.С., Урвачева Г.М., Шостак Н.А., Житарева И.В., Житомирская И.Ю.Chipigina N.S., Urvacheva G.M., Shostak N.A., Zhitareva I.V., Zhitomirskaya I.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/958

Background. The clinical significance of idiopathic mitral annular calcification (MAC) often diagnosed by echocardiography in elderly patients currently is not sufficiently studied. Aim. To study the clinical and echocardiographic characteristics of the cardiovascular system in patients with MAC aged 65 and older without diabetes mellitus and renal failure. Material and methods. Study included 100 patients with MAC, consecutively identified by 2D transthoracic echocardiography performed with relation to cardiovascular disease symptoms in 910 outpatients aged 65 years or older; the comparison group included 65 of consecutively studied patients without MAC. Results. Patients with MAC were older than patients without MAC (72.4±5.4 years vs 70.2±4.3 years; p<0.05) and had higher frequency of moderate or severe hypertension (99.0% vs 90.8%, p<0.05), myocardial infarction (adjusted incidence rate [AIR] 1.72; 95% confidence interval [CI] 1.12-2.55; р<0.05) and heart conduction disorders (AIR 3.25; 95%CI 2.45 to 4.30; р<0.05). At the same time the age-adjusted frequency of ischemic heart disease (AIR 1.12; 95%CI 0.9-1.39; р>0.05) and atrial fibrillation (AIR 0.94; 95%CI 0.52-1.56; р>0.05) was not significantly different in patients with and without MAC. Multivariate analysis adjusted for age and total cholesterol level obtained significant associations of MAC presence with symptomatic atherosclerotic peripheral arterial disease (p <0.001; ß=0.410). The frequency of stroke in patients with and without MAC did not differ (p>0.05). In the group of patients with MAC as compared to patients without MAC echocardiographic evaluation showed higher incidence of mitral regurgitation (AIR 1.51; 95%CI 1.21-1.82; p<0.05), left atrium increased size (AIR 1.68; 95%CI 1.27-2.23; p<0.05), concentric left ventricular hypertrophy (AIR 2.15; 95%CI 1.67-2.75; p<0.05), mitral valve thickening (100.0% vs 30.7%, p <0.001), aortic valve calcification (49% vs 0%, p <0.001), aortic regurgitation 1-2 degree (67.0% vs 13.9%, p <0.001). Conclusion. The study revealed some echocardiographic and clinical features associated with the MAC in elderly patients.

Актуальность. Клиническое значение идиопатического кальциноза кольца митрального клапана (КМК), часто диагностируемого при эхокардиографическом исследовании (ЭхоКГ) у пожилых больных, изучено недостаточно. Цель. Изучить клинические и эхокардиографические характеристики состояния сердечно-сосудистой системы у больных c КМК в возрасте от 65 лет и старше без сахарного диабета и почечной недостаточности. Материал и методы. В исследование были включены 100 больных с КМК, последовательно выявленных при трансторакальном 2ДЭхо-КГ исследовании, проведенном в связи с симптомами сердечно-сосудистых заболеваний среди 910 амбулаторных больных в возрасте от 65 лет и старше; 65 из последовательно обследованных больных, у которых не было выявлено КМК, составили группу сравнения. Результаты. Больные с КМК были старше больных без КМК (72,4±5,4 года в сравнении с 70,2±4,3; p<0,05); у них чаще, чем у больных без КМК, наблюдали артериальную гипертензию средней и тяжелой степени (99,0% по сравнению с 90,8%; р<0,05); у них была выше частота перенесенного инфаркта миокарда (стандартизованное отношение заболеваемости [СОЗ] 1,72; 95% доверительный интервал [ДИ] 1,12-2,55; р<0,05) и нарушений внутрисердечной проводимости (СОЗ 3,25; 95%ДИ 2,45-4,30; р<0,05). В то же время частота ишемической болезни сердца (СОЗ 1,12; 95%ДИ 0,9-1,39; р>0,05) и фибрилляции предсердий (СОЗ 0,94; 95%ДИ 0,52-1,56; р>0,05) после стандартизации по возрасту у больных с КМК и без КМК достоверно не отличались. При многофакторном анализе с учетом возраста и уровня общего холестерина получена достоверная связь наличия КМК с клинически выраженным атеросклерозом периферических артерий (р<0,001; ß=0,410). Частота перенесенного инсульта в группах больных с КМК и без КМК достоверно не различалась (р<0,05). В группе больных с КМК по сравнению с больными без КМК при эхокардиографической оценке была выше частота митральной регургитации (СОЗ 1,51; 95%ДИ 1,21-1,82; р<0,05), увеличения размера левого предсердия (СОЗ 1,68; 95%ДИ 1,27-2,23; р<0,05) и концентрической гипертрофии левого желудочка (СОЗ 2,15; 95%ДИ 1,67-2,75, р<0,05); чаще диагностировали утолщение створок митрального клапана (у 100% в сравнении с 30,7%; р<0,001), кальциноз аортального клапана (у 49,0% в сравнении с 0%; р<0,001), аортальную регургитацию 1-2 степени (у 67% в сравнении с 13,9%; р<0,001). Заключение. Выявлены некоторые закономерности изменений эхокардиографических показателей и особенности клиники, связанные с КМК у пожилых больных.

кальциноз кольца митрального клапанаишемическая болезнь сердцаэхокардиографиямитральная регургитацияремоделирование левого желудочкаmitral annular calcificationischemic heart diseaseechocardiographymitral regurgitationleft ventricular remodelingReferencesMovahed M., Saito Y., Ahmadi-Kashani M., Ebrahimi R. Mitral annulus calcification is associated with valvular and cardiac structural abnormalities. Cardiovasc Ultrasound 2007;5:14Movahed M., Saito Y., Ahmadi-Kashani M., Ebrahimi R. Mitral annulus calcification is associated with valvular and cardiac structural abnormalities. Cardiovasc Ultrasound 2007;5:14Fox C.S., Parise H., Vasan R.S. et al. Mitral annular calcification is a predictor for incident atrial fibrillation. Atherosclerosis 2004;173:291-294Fox C.S., Parise H., Vasan R.S. et al. Mitral annular calcification is a predictor for incident atrial fibrillation. Atherosclerosis 2004;173:291-294Kanjanauthai S., Nasir K., Katz R. et al. Relationship of mitral annular calcification to cardiovascular risk factors: The Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 2010; 213(2):558-62Kanjanauthai S., Nasir K., Katz R. et al. Relationship of mitral annular calcification to cardiovascular risk factors: The Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 2010; 213(2):558-62Koster N.K., Reddy Y.M., Schima S.M., Almeida N.J. Gender-specific echocardiographic findings in nonagenarians with cardiovascular disease. Am J Cardiol 2010;105(2):273-6.Koster N.K., Reddy Y.M., Schima S.M., Almeida N.J. Gender-specific echocardiographic findings in nonagenarians with cardiovascular disease. Am J Cardiol 2010;105(2):273-6.Sugiura M., Uchiyama S., Kuwako K. et al. A clinicopathological study on mitral ring calcification. Jpn Heart J 1977;18:154-63.Sugiura M., Uchiyama S., Kuwako K. et al. A clinicopathological study on mitral ring calcification. Jpn Heart J 1977;18:154-63.Zhang Y., Safar M.E., Iaria P. et al. Cardiac and arterial calcifications and all-cause mortality in the elderly: the PROTEGER Study. Atherosclerosis 2010;213(2):622-6.Zhang Y., Safar M.E., Iaria P. et al. Cardiac and arterial calcifications and all-cause mortality in the elderly: the PROTEGER Study. Atherosclerosis 2010;213(2):622-6.Ki Woo Seo, Eun Young Kim, Jeong Eun Kim et al. The Impact of Mitral Annular Calcification on Left Ventricular Function in Nonagenarians. Korean Circ J 2010; 40(6): 260–265.Ki Woo Seo, Eun Young Kim, Jeong Eun Kim et al. The Impact of Mitral Annular Calcification on Left Ventricular Function in Nonagenarians. Korean Circ J 2010; 40(6): 260–265.Arounlangsy P., Sawabe M., Izumiyama N., Koike M. Histopathogenesis of Early-stage Mitral Annular Calcification. J Med Dent Sci 2004; 51:35-44.Arounlangsy P., Sawabe M., Izumiyama N., Koike M. Histopathogenesis of Early-stage Mitral Annular Calcification. J Med Dent Sci 2004; 51:35-44.Pomerance A. Pathological and clinical study of calcification of the mitral valve ring. J Clin Path 1970;23: 354-36.Pomerance A. Pathological and clinical study of calcification of the mitral valve ring. J Clin Path 1970;23: 354-36.Johnson R.C., Leopold J.A., Loscalzo J. Vascular calcification: pathobiological mechanisms and clinical implications. Circ Res 2006;99(10):1044-59.Johnson R.C., Leopold J.A., Loscalzo J. Vascular calcification: pathobiological mechanisms and clinical implications. Circ Res 2006;99(10):1044-59.Sell S., Scully R.E. Aging changes in aortic and mitral valves. Histologic and histochemical studies, with observations on the pathogenesis of calcific aortic stenosis and calcification of the mitral annulus. Am J Pathol 1965;46:345-65.Sell S., Scully R.E. Aging changes in aortic and mitral valves. Histologic and histochemical studies, with observations on the pathogenesis of calcific aortic stenosis and calcification of the mitral annulus. Am J Pathol 1965;46:345-65.Sherif H.M. Calcification of left-sided valvular structures: evidence of a pro-inflammatory milieu. J Heart Valve Dis 2009;18(1):52-60.Sherif H.M. Calcification of left-sided valvular structures: evidence of a pro-inflammatory milieu. J Heart Valve Dis 2009;18(1):52-60.Chu H., Chen J., Guo R. The association between cardiac calcification and coronary artery disease. Acta Cardiol 2009;64(4):531-5.Chu H., Chen J., Guo R. The association between cardiac calcification and coronary artery disease. Acta Cardiol 2009;64(4):531-5.Atar S., Jeon D.S., Luo H., Siegel R.J. Mitral annular calcification: a marker of severe coronary artery disease in patients under 65 years old. Heart 2003;89:161-164.Atar S., Jeon D.S., Luo H., Siegel R.J. Mitral annular calcification: a marker of severe coronary artery disease in patients under 65 years old. Heart 2003;89:161-164.Fox C.S., Vasan R.S., Parise H. et al. Mitral annular calcification predicts cardiovascular morbidity and mortality: the Framingham Heart Study. Circulation 2003;107:1492-6.Fox C.S., Vasan R.S., Parise H. et al. Mitral annular calcification predicts cardiovascular morbidity and mortality: the Framingham Heart Study. Circulation 2003;107:1492-6.Kohsaka S., Jin Z., Rundek T. et al. Impact of mitral annular calcification on cardiovascular events in a multiethnic community. The Northern Manhattern Study. JACC Cardiovasc Imaging 2008;1(5): 617-23.Kohsaka S., Jin Z., Rundek T. et al. Impact of mitral annular calcification on cardiovascular events in a multiethnic community. The Northern Manhattern Study. JACC Cardiovasc Imaging 2008;1(5): 617-23.Chipigina N.S., Urvacheva G.M., Shostak N.A. Clinical importance of idiopathic mitral annular calcification. Rational Pharmacother Card 2011;7(4):483-486. Russian (Чипигина Н.С., Урвачева Г.М., Шостак Н.А. Клиническое значение кальциноза кольца митрального клапана. Рациональная фармакотерапия в Кардиологии 2011; 4:483-485).Chipigina N.S., Urvacheva G.M., Shostak N.A. Clinical importance of idiopathic mitral annular calcification. Rational Pharmacother Card 2011;7(4):483-486. Russian (Чипигина Н.С., Урвачева Г.М., Шостак Н.А. Клиническое значение кальциноза кольца митрального клапана. Рациональная фармакотерапия в Кардиологии 2011; 4:483-485).Gorokhova S.G., Arakeliants A.A. Calcinosis of the heart valves — a chance finding or serious diagnosis? Ter Arkh 2005;77(4):87-90. Russian (Горохова С.Г., Аракелянц А.А. Кальциноз клапанов сердца — случайная находка или серьезный диагноз? Терапевтический архив 2005; 4: 87-90).Gorokhova S.G., Arakeliants A.A. Calcinosis of the heart valves — a chance finding or serious diagnosis? Ter Arkh 2005;77(4):87-90. Russian (Горохова С.Г., Аракелянц А.А. Кальциноз клапанов сердца — случайная находка или серьезный диагноз? Терапевтический архив 2005; 4: 87-90).Muddassir S.M., Pressman G.N. Mitral annular calcification as a cause of mitral valve gradients. Int J Cardiol 2007;123(1):58-62.Muddassir S.M., Pressman G.N. Mitral annular calcification as a cause of mitral valve gradients. Int J Cardiol 2007;123(1):58-62.Adler Y., Fink N., Spector D. et al. Mitral annulus calcification – a window to diffuse atherosclerosis of the vascular system. Atherosclerosis 2001;155(1):1-8.Adler Y., Fink N., Spector D. et al. Mitral annulus calcification – a window to diffuse atherosclerosis of the vascular system. Atherosclerosis 2001;155(1):1-8.Pressman G.S., Crudu V., Parameswaran-Chandrika A. Can total cardiac calcium predict the coronary calcium score? Int J Cardiol 2011;146(2):202-6.Pressman G.S., Crudu V., Parameswaran-Chandrika A. Can total cardiac calcium predict the coronary calcium score? Int J Cardiol 2011;146(2):202-6.Utsunomiya H., Yamamoto H., Kunita E. et al. Combined presence of aortic valve calcification and mi-tral annular calcification as a marker of the extent and vulnerable characteristics of coronary artery plaque assessed by 64-multidetector computed tomography. Atherosclerosis 2010;213(1):166-72.Utsunomiya H., Yamamoto H., Kunita E. et al. Combined presence of aortic valve calcification and mi-tral annular calcification as a marker of the extent and vulnerable characteristics of coronary artery plaque assessed by 64-multidetector computed tomography. Atherosclerosis 2010;213(1):166-72.Bischof T., Schneider J. Degenerative calcification of mitral and aortic valves. Schweiz Rundsch Med Prax 1992;81(19):626-31.Bischof T., Schneider J. Degenerative calcification of mitral and aortic valves. Schweiz Rundsch Med Prax 1992;81(19):626-31.Allison M.A., Cheung P., Criqui M.H., Langer R.D., Wright C.M. Mitral and aortic annular calcification are highly associated with systemic calcified atherosclerosis. Circulation 2006; 113: 861–866.Allison M.A., Cheung P., Criqui M.H., Langer R.D., Wright C.M. Mitral and aortic annular calcification are highly associated with systemic calcified atherosclerosis. Circulation 2006; 113: 861–866.Adler Y., Levinger U., Koren A. et al. Association between mitral annulus calcification and peripheral arterial atherosclerotic disease. Angiology 2000;51(8):639-46.Adler Y., Levinger U., Koren A. et al. Association between mitral annulus calcification and peripheral arterial atherosclerotic disease. Angiology 2000;51(8):639-46.Benjamin E.J., Plehn J.F., D’Agostino R.B. et al. Mitral annular calcification and the risk of stroke in an elderly cohort. N Engl J Med 1992;327:374-9Benjamin E.J., Plehn J.F., D’Agostino R.B. et al. Mitral annular calcification and the risk of stroke in an elderly cohort. N Engl J Med 1992;327:374-9Predictors of thromboembolism in atrial fibrillation: II. Echocardiographic features of patients at risk. The Stroke Prevention in Atrial Fibrillation Investigators. Ann Intern Med 1992;116:6–12.Predictors of thromboembolism in atrial fibrillation: II. Echocardiographic features of patients at risk. The Stroke Prevention in Atrial Fibrillation Investigators. Ann Intern Med 1992;116:6–12.Gardin J.M., McClelland R., Kitzman D. et al. M-mode echocardiographic predictors of six- to seven-year incidence of coronary heart disease, stroke, congestive heart failure, and mortality in an elderly cohort (The Cardiovascular Health Study). Am J Cardiol 2001; 87: 1051–1057.Gardin J.M., McClelland R., Kitzman D. et al. M-mode echocardiographic predictors of six- to seven-year incidence of coronary heart disease, stroke, congestive heart failure, and mortality in an elderly cohort (The Cardiovascular Health Study). Am J Cardiol 2001; 87: 1051–1057.Rodriguez C.J., Bartz T.M., Longstreth W.T. et al. Association of Annular Calcification and Aortic Valve Sclerosis With Brain Findings on Magnetic Resonance Imaging in Community Dwelling Older Adults. The Cardiovascular Health Study. J Am Coll Cardiol 2011; 57:2172-2180.Rodriguez C.J., Bartz T.M., Longstreth W.T. et al. Association of Annular Calcification and Aortic Valve Sclerosis With Brain Findings on Magnetic Resonance Imaging in Community Dwelling Older Adults. The Cardiovascular Health Study. J Am Coll Cardiol 2011; 57:2172-2180.Mellino M., Salcedo E.E., Lever H.M. et al. Echographic-quantified severity of mitral anulus calcification: prognostic correlation to related hemodynamic, valvular, rhythm, and conduction abnormalities. Am Heart J 1982;103(2):222-5.;Mellino M., Salcedo E.E., Lever H.M. et al. Echographic-quantified severity of mitral anulus calcification: prognostic correlation to related hemodynamic, valvular, rhythm, and conduction abnormalities. Am Heart J 1982;103(2):222-5.;Ariyarajah V., Apiyasawat S., Barac I., Spodick D.H. Is the presence of mitral annular calcification associated with poor left atrial function? Echocardiography 2009;26(8):877-84.Ariyarajah V., Apiyasawat S., Barac I., Spodick D.H. Is the presence of mitral annular calcification associated with poor left atrial function? Echocardiography 2009;26(8):877-84.Sahasakul Y., Edwards W.D., Naessens J.M., Tajik A.J. Age-related changes in aortic and mitral valve thickness: implications for two-dimensional echocardiography based on an autopsy study of 200 normal human hearts. Am J Cardiol 1988;62(7):424-30.Sahasakul Y., Edwards W.D., Naessens J.M., Tajik A.J. Age-related changes in aortic and mitral valve thickness: implications for two-dimensional echocardiography based on an autopsy study of 200 normal human hearts. Am J Cardiol 1988;62(7):424-30.Fulkerson P.K., Beaver B.M., Auseon J.C., Graber H.L. Calcification of the mitral annulus: etiology, clinical associations and therapy. Am J Med 1979; 66(6):967-977.Fulkerson P.K., Beaver B.M., Auseon J.C., Graber H.L. Calcification of the mitral annulus: etiology, clinical associations and therapy. Am J Med 1979; 66(6):967-977.Foppa M., Duncan B.B., Rohde L. Echocardiography-based left ventricular mass estimation. How should we define hypertrophy? Cardiovascular Ultrasound 2005; (3):17.Foppa M., Duncan B.B., Rohde L. Echocardiography-based left ventricular mass estimation. How should we define hypertrophy? Cardiovascular Ultrasound 2005; (3):17.Balyabin A.A. The atrioventricular conduction disorders at a calcification of the mitral valve ring. Trudy Instituta LenGIDUV im. S.M.Kirova 1986:38-41. Russian (Балябин А.А. Нарушения атриовентрикулярной проводимости при кальцинозе кольца митрального клапана. Труды института Лен-ГИДУВ им. С.М.Кирова 1986:38-41).Balyabin A.A. The atrioventricular conduction disorders at a calcification of the mitral valve ring. Trudy Instituta LenGIDUV im. S.M.Kirova 1986:38-41. Russian (Балябин А.А. Нарушения атриовентрикулярной проводимости при кальцинозе кольца митрального клапана. Труды института Лен-ГИДУВ им. С.М.Кирова 1986:38-41).

The authors declare that there are no conflicts of interest present.