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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 2, March/April 2019
AFRICA
75
Cardiovascular Topics
Association between coronary tortuosity and mitral
annular calcification
Levent Cerit, Zeynep Cerit
Abstract
Introduction:
Coronary tortuosity (CorT) is a common coro-
nary angiographic finding. The aetiology, clinical implication
and long-term prognosis are not well clarified. Mitral annu-
lar calcification (MAC) is one of the most common cardiac
structural abnormalities on echocardiographic examination.
MAC and CorT are associated with atherosclerotic risk
factors such as advanced age, hypertension, diabetes mellitus,
hypercholesterolaemia, female gender and chronic kidney
disease. There are few data on the co-existence of MAC and
CorT in the literature. This study was conducted with the aim
of evaluating the association between CorT and MAC.
Methods:
The medical records of consecutive patients
who underwent coronary angiography were retrospectively
reviewed. The study group consisted of 2 736 patients. Taking
into consideration the inclusion criteria, 392 patients with
MAC and 687 patients without MAC (control group) were
included in the study. Biochemical, clinical and echocardio-
graphic parameters and CorT were evaluated in all patients.
CorT was defined as three fixed bends during both systole
and diastole, with the angle of each bend 45° or more
Results:
Patients with MAC had a higher prevalence of hyper-
tension, hyperlipidaemia, female gender, MAC and advanced
age. On univariate analysis, advanced age, hypertension, female
gender, hyperlipidaemia and MAC were associated with CorT.
On multivariate analysis MAC, advanced age and hypertension
were independent predictors for CorT (OR 2.167, 95% CI:
1.436–4.283,
p
<
0.001; OR 1.243, 95% CI: 1.243–3.674,
p
<
0.001; OR 2.358, 95% CI: 1.864–4.681,
p
<
0.001, respectively).
Conclusion:
In our study, we found a significant relationship
between MAC and CorT.
Keywords:
mitral annular calcification, coronary tortuosity,
hypertension, female gender, ageing
Submitted 19/9/17, accepted 6/11/18
Published online 30/11/18
Cardiovasc J Afr
2019;
30
: 75–78
www.cvja.co.zaDOI: 10.5830/CVJA-2018-068
Mitral annular calcification (MAC) is a chronic, progressive
process, characterised by calcium deposition on the mitral valve
annulus. The incidence of MAC is 2.7% in the general population
older than 50 years. MAC is a chronic degenerative process, and
the prevalence of MAC is increasing in the developed world
due to the growing population of elderly patients, and risk
factors such as hypertension (HT), hypercholesterolaemia (HL),
diabetes mellitus (DM), female gender and chronic kidney
disease. MAC has been shown to be a predictor of systemic
atherosclerosis, cardiac arrhythmias, conduction abnormalities
and vascular diseases such as coronary artery disease (CAD)
and stroke.
1,2
Severe MAC is related to the severity of calcium
deposition in the coronary vasculature.
3
Coronary tortuosity (CorT) is a common coronary
angiographic finding. It is defined as three fixed bends during
both systole and diastole in at least a single epicardial artery,
with each change in the vessel direction a 45° bend.
4
Clinical
studies have demonstrated that CorT is associated with ageing,
HT, HL, atherosclerosis and DM.
5-7
The association between MAC and CorT has not been
studied. In the light of this knowledge, we aimed to determine
the relationship between the CorT and MAC.
Methods
The study group consisted of 2 736 consecutive patients who
underwent coronary angiography after to a positive treadmill test.
A retrospective evaluation of consecutive patients undergoing
coronary angiography was performed. Stable angina was defined
as discomfort in the chest, back, jaw, shoulder or arm, typically
elicited by exertion or emotional stress, and relieved by rest or
nitroglycerin.
All patients enrolled in the study underwent coronary
angiography as a result of chest pain and objective signs of
ischaemia during treadmill exercises. Taking into consideration
the inclusion criteria, 392 patients with MAC and 687 patients
without MAC (control group) were included in the study. We
excluded patients with severe coronary artery disease (left main
coronary artery and proximal left anterior descending artery
>
50%, other coronary arteries
>
70% blockage) and previous
myocardial infarction.
The data of patients were retrospectively analysed for
demographic features and echocardiographic parameters,
including ejection fraction, MAC, biochemical parameters, and
CorT. The study was approved by the local ethics committee.
All patients underwent transthoracic echocardiography using
a Vivid S5 (GE Healthcare) echocardiography device and Mass
Department of Cardiology, Near East University Hospital,
Nicosia, Cyprus
Levent Cerit, MD,
drcerit@hotmail.comDepartment of Paediatric Cardiology, Near East University
Hospital, Nicosia, Cyprus
Zeynep Cerit, MD