Evaluation of aortic valve, mitral valve, aortic root calcification as a marker of atherosclerosis extent

Background: Previously accepted as a passive degenerative consequence of aging, aortic valve calcification and mitral valve annulus calcification are now recognized as active processes with histological similarities to coronary arteries atherosclerosis.Aim: Thus, this study aimed to evaluate: 1) the value of the combined presence of aortic valve calcification, mitral annulus calcification and aortic root calcification determined by using echocardiography in predicting the presence and extent of coronary angiographic atherosclerotic coronary plaque in patients with suspected coronary artery disease, 2) the relationship between traditional cardiovascular disease risk factors (including high sensitive CRP, lipopretein (a), homocyctein), and aortic valve calcification, mitral annulus calcification and aortic root calcification, 3) the association of aortic valve calcification, mitral annulus calcification and aortic root calcification with other measures of subclinical atherosclerosis, namely carotid/brachial artery intima-media thickness and, as well as angiographic atherosclerotic burden in patients undergoing coronary angiography.Methods: We enrolled 146 consecutive patients with proven or suspected coronary artery disease who were referred for coronary angiography at our institution have been selected. The study is comprised of 63% men and 37% women aged 26-80 years (mean age 52.74 ? 8.93). After taking a detailed clinical history, with special attention to risk factor identification, all patients underwent complete transthoracic echocardiographic examination and Carotid and brachial arteries Duplex sonography before underwent coronary angiography on different days. We used the Gensini score for this study to test the burden of atherosclerosis.Results: AVC significantly associated with MAC and ARC (p=0.021, p=0.001, respectively). The LCC-IMT, RCC-IMT, mean CC-IMT, MaxCC-IMT and BA-IMT values were significantly higher in the AVC subjects than without AVC (p=0.001 for all parameters). Notably, individuals with AVC were found to have higher Gensini score (42.49 vs 8.21, p=0.001). The LCC-IMT, RCC-IMT, mean CC-IMT, MaxCC-IMT and BA-IMT values were significantly higher in the MAC subjects than without MAC (p=0.017, p=0.018, p=0.008, p=0.011, p=0.003, respectively). Subjects with MAC were found to have higher Gensini score (46.22 vs 23.03, p=0.002). ARC. ARC significantly associated with AVC and MAC (p=0.001).The LCC-IMT, RCC-IMT, mean CC-IMT, MaxCC-IMT and BA-IMT values were significantly higher in the ARC subjects than without ARC (p=0.001 for all parameters). Notably, individuals with AVC were found to have higher Gensini score (43.11 vs 12.34, p=0.001).Conclusion: AVC, MAC and ARC are highly prevalent in patients undergoing coronary angiography and strongly correlated with each other. The presence of AVC, MAC, or ARC by echocardiography is highly associated with peripheric atherosclerosis and presence and extent of coronary atherosclerosis. These calcification should be accepted a manifestation of later stage of atherosclerosis and thus, aggrassive preventive approach, independent from the presence of risk factors, may be warranted to retard the atherosclerosis process.Key words: Aortic Valve Calcification, Mitral Annular Calcification, Aortic Root Calcification, Gensini Score