Association of Annular Calcification and Aortic Valve Sclerosis With Brain Findings on Magnetic Resonance Imaging in Community Dwelling Older Adults

Department of Epidemiology and Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
Journal of the American College of Cardiology (Impact Factor: 16.5). 05/2011; 57(21):2172-80. DOI: 10.1016/j.jacc.2011.01.034
Source: PubMed


The objective of this study was to investigate the associations of mitral annular calcification, aortic annular calcification, and aortic valve sclerosis with covert magnetic resonance imaging (MRI)-defined brain infarcts.
Clinically silent brain infarcts defined by MRI are associated with increased risk for cognitive decline, dementia, and future overt stroke. Left-sided cardiac valvular and annular calcifications are suspected as risk factors for clinical ischemic stroke.
A total of 2,680 CHS (Cardiovascular Health Study) participants without clinical histories of stroke or transient ischemic attack underwent brain MRI in 1992 and 1993, 1 to 2 years before echocardiographic exams (1994 to 1995).
The mean age of the participants was 74.5 ± 4.8 years, and 39.3% were men. The presence of any annular or valvular calcification (mitral annular calcification, aortic annular calcification, or aortic valve sclerosis), mitral annular calcification alone, or aortic annular calcification alone was significantly associated with a higher prevalence of covert brain infarcts in unadjusted analyses (p < 0.01 for all). In models adjusted for age, sex, race, body mass index, physical activity, creatinine, systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, smoking, diabetes, coronary heart disease, and congestive heart failure, the presence of any annular or valve calcification remained associated with covert brain infarcts (risk ratio: 1.24; 95% confidence interval: 1.05 to 1.47). The degree of annular or valvular calcification severity showed a direct relation with the presence of covert MRI findings.
Left-sided cardiac annular and valvular calcifications are associated with covert MRI-defined brain infarcts. Further study is warranted to identify mechanisms and determine whether intervening in the progression of annular and valvular calcification could reduce the incidence of covert brain infarcts as well as the associated risk for cognitive impairment and future stroke.

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Available from: Traci M Bartz, May 19, 2014
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    • "This is supported by work done by Rodriguez and colleagues in a community-based study of 2680 participants from the Cardiovascular Health Study who underwent MRI analysis. Participants, without prior history of stroke, with left-sided annular or valvular calcification had a 33% greater risk of covert brain infarcts.81 Coupled with other studies demonstrating the presence of brain infarcts in association with calcification of the aortic valve, this supports the association between valve disease and a higher risk of both stroke and cognitive decline.82–84 "
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    • "Notably, the combined presence of AVS and MAC was more strongly associated with an increased risk of all-cause and CVD mortality than the presence of either item alone. Collectively, the results of this study complement and expand previous observations on the value of AVS and MAC for predicting mortality both in the general population and in other nondiabetic high-risk patient populations (1,4–9,18). "
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