Association of mitral annular calcification with endothelial dysfunction , carotis intima media thickness and serum Fetuin-A level

Introduction : Mitral anular calcification (MAC) is a disease characterized by the degenerative calcification of the mitral valve annulus. Basic pathology is the transformation of collagen structure of mitral annulus to fibrous structure, lipid deposition and then calcification. It? s thought that atherosclerotic processes are playing role in the progression MAC, just like coronary artery disease (CAD). It?s known that the endothelial dysfunction occurs in CAD and carotis intima media thickness (CIMT) is raised. Fetuin-A is one of the plasma glycoproteins which is the most important inhibitor of pathological calcification.Objectives : In this study, we examined association between MAC and endothelial dysfunction, CIMT, and serum fetuin-A levelsMaterials and Methods : Subjects are selected from our hospitalized patients, who had CAD proved with coronary angiography. According to the inclusion criteria, their ages were between 45-86 (mean 64,9±8,2) with 40 subjects having MAC in trans torasic echocardiography.and 40 subjects without MAC. Endothelial functions were assesed by endothelial derived vasodilatatory response (EDVR), and nitrate derived vasodilatatory response (NDVR) in brachial artery ultrasound. CIMT were measured from posterior wall of the bilateral common carotis artery with the help of ultrasonographic examination and avarage value was obtained. Serum fetuin-A and other biochemical parameters were examined in the 12 fasting blood.Results : There were statistically significant difference in biochmical and demographic findings. EDVR was significantly lower in MAC group. Avarage CIMT in MAC group was1,13±0,2 and 0,94±0,3 in control group. The difference was statistically significant. There was a strong positive correlation between EDRV and serum fetuin-A. There was a strong negative correlation between CIMT and EDRV, moderately negative correlation between CIMT and serum fetuin-A level. 2,93 ng/ml cut-off value for serum fetuin-A level can be used to diagnose MAC in % 72,5 sensitivity and %62,5 specificity. On the ather hand 1 mm cut-off value for CIMT can also be used to diagnose MAC in % 67,5 sensitivity and %65 specificity.Conclusion : In this study, we confirmed that MAC development is a similar process with atherosclerosis. That may be because MAC is a form of atherosclerosis. MAC is closely related with CIMT and serum fetuin-A level. This finding can explain the relation between MAC and serum fetuin-A. On the other hand serum fetuin-A and CIMT can be used as independent parameter diagnosis of MAC. In cocnclusion, MACcan be diagnosed easily with echocardiography and can be used as an early determinant of CAD which is an increasing antity in the world.