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Original Research: Cardiovascular Disease |

Mitral Annular Calcification Predicts Cardiovascular Morbidity and Mortality in Middle-aged Patients With Atrial FibrillationMitral Annular Calcification and Mortality: The Belgrade Atrial Fibrillation Study

Tatjana S. Potpara, MD, PhD; Zorana M. Vasiljevic, MD, PhD; Bosiljka D. Vujisic-Tesic, MD, PhD; Jelena M. Marinkovic, PhD; Marija M. Polovina, MD; Jelena M. Stepanovic, MD, PhD; Goran R. Stankovic, MD, PhD; Miodrag C. Ostojic, MD, PhD; Gregory Y. H. Lip, MD
Author and Funding Information

From the Cardiology Clinic (Drs Potpara, Vasiljevic, Vujisic-Tesic, Polovina, Stepanovic, Stankovic, and Ostojic), Clinical Center of Serbia; and the Institute for Medical Statistics (Dr Marinkovic), Faculty of Medicine (Drs Vasiljevic, Vujisic-Tesic, Stepanovic, Stankovic, and Ostojic), University of Belgrade, Serbia; and the University of Birmingham Centre for Cardiovascular Sciences (Dr Lip), City Hospital, Birmingham, England.

Correspondence to: Tatjana Potpara, MD, PhD, Cardiology Clinic, Clinical Center of Serbia, Koste Todorovica 8, 11 000 Belgrade, Serbia; e-mail: spotpara@sbb.rs


Funding/Support: The research was in part supported by National Ministry of Health and Technology, RS [175086, III41022 and 175084].

For editorial comment see page 843

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(4):902-910. doi:10.1378/chest.10-2963
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Background:  Mitral annular calcification (MAC) has been suggested as a reliable, time-averaged marker of atherosclerosis and is associated with coronary artery disease, heart failure, ischemic stroke, and increased mortality. Data on the relationship between MAC and cardiovascular morbidity and mortality in atrial fibrillation (AF) are sparse, with the exception of the relationship between MAC and stroke. We investigated the association of MAC with cardiovascular morbidity, stroke, cardiovascular mortality, and all-cause death in a cohort of middle-aged patients with AF with a mean 10-year follow-up.

Methods:  This was an observational study of patients with nonvalvular AF between 1992 and 2007.

Results:  Of 1,056 patients, 33 (3.1%) had MAC; they were more likely to be older and female and to have a dilated left atrium, reduced left ventricular ejection fraction, permanent AF, hypertension, and/or diabetes mellitus (all P < .05). Total follow-up was 10,418.5 years (mean, 9.9 ± 5.9 years), and the mean age was 52.7 ± 12.2 years. In univariate analysis, MAC was associated with all-cause death, cardiovascular death, stroke, new cardiac morbidity (all P < .05), and the composite end point of ischemic stroke, myocardial infarction (MI), and all-cause death (P < .001). In multivariate analyses, MAC was related to all-cause death (hazard ratio [HR], 4.3; 95% CI, 1.8-10.0; P < .001), cardiovascular death (HR, 3.5; 95% CI, 1.2-10.4; P = .025), the composite end point (HR, 2.1; 95% CI, 1.0-4.3; P = .048), and new cardiac morbidity (HR, 2.4; 95% CI, 1.3-4.5; P = .005). There was no significant relationship between MAC and stroke or MI in the multivariate analyses.

Conclusions:  MAC is associated with increased cardiovascular morbidity, cardiovascular mortality, and all-cause mortality of patients with AF. MAC should be acknowledged as a marker of increased cardiovascular risk in middle-aged patients with AF.

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