Mitral valve sclerosis: Difference between revisions
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==Overview== | |||
Mitral sclerosis is a degenerative process that involves the annular ring of the mitral valve and commonly affects the elderly population aged above 50-60 years.<ref name="pmid15632881">{{cite journal |author=Fox E, Harkins D, Taylor H, McMullan M, Han H, Samdarshi T, Garrison R, Skelton T |title=Epidemiology of mitral annular calcification and its predictive value for coronary events in African Americans: the Jackson Cohort of the Atherosclerotic Risk in Communities Study |journal=[[American Heart Journal]] |volume=148 |issue=6 |pages=979–84 |year=2004 |month=December |pmid=15632881 |doi=10.1016/j.ahj.2004.05.048 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002870304003680 |accessdate=2012-04-11}}</ref><ref name="pmid6846165">{{cite journal |author=Savage DD, Garrison RJ, Castelli WP, McNamara PM, Anderson SJ, Kannel WB, Feinleib M |title=Prevalence of submitral (anular) calcium and its correlates in a general population-based sample (the Framingham Study) |journal=[[The American Journal of Cardiology]] |volume=51 |issue=8 |pages=1375–8 |year=1983 |month=May |pmid=6846165 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/0002-9149(83)90315-6 |accessdate=2012-04-11}}</ref><ref name="pmid16368289">{{cite journal |author=Barasch E, Gottdiener JS, Larsen EK, Chaves PH, Newman AB, Manolio TA |title=Clinical significance of calcification of the fibrous skeleton of the heart and aortosclerosis in community dwelling elderly. The Cardiovascular Health Study (CHS) |journal=[[American Heart Journal]] |volume=151 |issue=1 |pages=39–47 |year=2006 |month=January |pmid=16368289 |doi=10.1016/j.ahj.2005.03.052 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-8703(05)00354-6 |accessdate=2012-04-11}}</ref> | |||
==Pathophysiology== | |||
The pathophysiologic process for mitral sclerosis is similar to that of [[aortic sclerosis]] and is also associated with increase incidence of newer adverse coronary events.<ref name="pmid15632881">{{cite journal |author=Fox E, Harkins D, Taylor H, McMullan M, Han H, Samdarshi T, Garrison R, Skelton T |title=Epidemiology of mitral annular calcification and its predictive value for coronary events in African Americans: the Jackson Cohort of the Atherosclerotic Risk in Communities Study |journal=[[American Heart Journal]] |volume=148 |issue=6 |pages=979–84 |year=2004 |month=December |pmid=15632881 |doi=10.1016/j.ahj.2004.05.048 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002870304003680 |accessdate=2012-04-11}}</ref><ref name="pmid16461818">{{cite journal |author=Allison MA, Cheung P, Criqui MH, Langer RD, Wright CM |title=Mitral and aortic annular calcification are highly associated with systemic calcified atherosclerosis |journal=[[Circulation]] |volume=113 |issue=6 |pages=861–6 |year=2006 |month=February |pmid=16461818 |doi=10.1161/CIRCULATIONAHA.105.552844 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16461818 |accessdate=2012-04-11}}</ref><ref name="pmid12654605">{{cite journal |author=Fox CS, Vasan RS, Parise H, Levy D, O'Donnell CJ, D'Agostino RB, Benjamin EJ |title=Mitral annular calcification predicts cardiovascular morbidity and mortality: the Framingham Heart Study |journal=[[Circulation]] |volume=107 |issue=11 |pages=1492–6 |year=2003 |month=March |pmid=12654605 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=12654605 |accessdate=2012-04-11}}</ref> | |||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
Among [[diabetes|diabetics]] with [[renal dysfunction|impaired kidney function]], the incidence of mitral valve sclerosis is much higher than the incidence of [[aortic sclerosis]].<ref name="pmid17720520">{{cite journal |author=Ix JH, Shlipak MG, Katz R, Budoff MJ, Shavelle DM, Probstfield JL, Takasu J, Detrano R, O'Brien KD |title=Kidney function and aortic valve and mitral annular calcification in the Multi-Ethnic Study of Atherosclerosis (MESA) |journal=[[American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation]] |volume=50 |issue=3 |pages=412–20 |year=2007 |month=September |pmid=17720520 |doi=10.1053/j.ajkd.2007.05.020 |url=http://linkinghub.elsevier.com/retrieve/pii/S0272-6386(07)00892-X |accessdate=2012-04-10}}</ref> | Among [[diabetes|diabetics]] with [[renal dysfunction|impaired kidney function]], the incidence of mitral valve sclerosis is much higher than the incidence of [[aortic sclerosis]].<ref name="pmid17720520">{{cite journal |author=Ix JH, Shlipak MG, Katz R, Budoff MJ, Shavelle DM, Probstfield JL, Takasu J, Detrano R, O'Brien KD |title=Kidney function and aortic valve and mitral annular calcification in the Multi-Ethnic Study of Atherosclerosis (MESA) |journal=[[American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation]] |volume=50 |issue=3 |pages=412–20 |year=2007 |month=September |pmid=17720520 |doi=10.1053/j.ajkd.2007.05.020 |url=http://linkinghub.elsevier.com/retrieve/pii/S0272-6386(07)00892-X |accessdate=2012-04-10}}</ref> | ||
==Causes== | |||
*[[Hyperparathyroidism|Primary Hyperparathyroidism]] | |||
==Complication== | |||
Kizer JR et al,<ref name="pmid16254219">{{cite journal |author=Kizer JR, Wiebers DO, Whisnant JP, Galloway JM, Welty TK, Lee ET, Best LG, Resnick HE, Roman MJ, Devereux RB |title=Mitral annular calcification, aortic valve sclerosis, and incident stroke in adults free of clinical cardiovascular disease: the Strong Heart Study |journal=[[Stroke; a Journal of Cerebral Circulation]] |volume=36 |issue=12 |pages=2533–7 |year=2005 |month=December |pmid=16254219 |doi=10.1161/01.STR.0000190005.09442.ad |url=http://stroke.ahajournals.org/cgi/pmidlookup?view=long&pmid=16254219 |accessdate=2012-04-11}}</ref> demonstrated that mitral valve calcification remained a strong risk factor for incident [[stroke]] after extensive adjustment for other predictors. | |||
==Treatment== | |||
===2008 ACCP Guidelines Recommendation <ref name="pmid18574274">{{cite journal |author=Salem DN, O'Gara PT, Madias C, Pauker SG |title=Valvular and structural heart disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) |journal=[[Chest]] |volume=133 |issue=6 Suppl |pages=593S–629S |year=2008 |month=June |pmid=18574274 |doi=10.1378/chest.08-0724 |url=http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=18574274 |accessdate=2012-04-10}}</ref>=== | |||
{{cquote| | |||
====[[ACCP guidelines classification scheme#Grading Scheme Classification|Grade 1]]==== | |||
'''1.''' In patients with mitral annular calcification complicated by systemic embolism, [[ischemic stroke]], or [[transient ischemic attack]], who do not have [[atrial fibrillation]], we recommend [[aspirin]] (50 to 100 mg/d). ''([[ACCP guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' | |||
'''2.''' In patients with mitral annular calcification and [[atrial fibrillation]], we recommend [[VKA|vitamin K antagonist]] therapy (target INR, 2.5; range, 2.0 to 3.0). ''([[ACCP guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' | |||
====[[ACCP guidelines classification scheme#Grading Scheme Classification|Grade 2]]==== | |||
'''1.''' For recurrent events despite [[aspirin]] therapy, we suggest treatment with [[VKA|vitamin K antagonist]] therapy be considered (target INR, 2.5; range, 2.0 to 3.0). ''([[ACCP guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' In patients with mitral annular calcification who have a single embolus documented to be calcific, the data are not sufficient to allow recommendation for or against antithrombotic therapy.}} | |||
==Guidelines Resources== | |||
*[http://chestjournal.chestpubs.org/content/133/6_suppl/593S.long#sec-1 Valvular and Structural Heart Disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)]<ref name="pmid18574274">{{cite journal |author=Salem DN, O'Gara PT, Madias C, Pauker SG |title=Valvular and structural heart disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) |journal=[[Chest]] |volume=133 |issue=6 Suppl |pages=593S–629S |year=2008 |month=June |pmid=18574274 |doi=10.1378/chest.08-0724 |url=http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=18574274 |accessdate=2012-04-10}}</ref> | |||
==References== | ==References== | ||
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{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Disease]] | |||
[[Category:Cardiology]] | |||
Latest revision as of 19:25, 26 August 2017
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]
Overview
Mitral sclerosis is a degenerative process that involves the annular ring of the mitral valve and commonly affects the elderly population aged above 50-60 years.[1][2][3]
Pathophysiology
The pathophysiologic process for mitral sclerosis is similar to that of aortic sclerosis and is also associated with increase incidence of newer adverse coronary events.[1][4][5]
Epidemiology and Demographics
Among diabetics with impaired kidney function, the incidence of mitral valve sclerosis is much higher than the incidence of aortic sclerosis.[6]
Causes
Complication
Kizer JR et al,[7] demonstrated that mitral valve calcification remained a strong risk factor for incident stroke after extensive adjustment for other predictors.
Treatment
2008 ACCP Guidelines Recommendation [8]
| “ |
Grade 11. In patients with mitral annular calcification complicated by systemic embolism, ischemic stroke, or transient ischemic attack, who do not have atrial fibrillation, we recommend aspirin (50 to 100 mg/d). (Level of Evidence: B) 2. In patients with mitral annular calcification and atrial fibrillation, we recommend vitamin K antagonist therapy (target INR, 2.5; range, 2.0 to 3.0). (Level of Evidence: C) Grade 21. For recurrent events despite aspirin therapy, we suggest treatment with vitamin K antagonist therapy be considered (target INR, 2.5; range, 2.0 to 3.0). (Level of Evidence: C) In patients with mitral annular calcification who have a single embolus documented to be calcific, the data are not sufficient to allow recommendation for or against antithrombotic therapy. |
” |
Guidelines Resources
- Valvular and Structural Heart Disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)[8]
References
- ↑ 1.0 1.1 Fox E, Harkins D, Taylor H, McMullan M, Han H, Samdarshi T, Garrison R, Skelton T (2004). "Epidemiology of mitral annular calcification and its predictive value for coronary events in African Americans: the Jackson Cohort of the Atherosclerotic Risk in Communities Study". American Heart Journal. 148 (6): 979–84. doi:10.1016/j.ahj.2004.05.048. PMID 15632881. Retrieved 2012-04-11. Unknown parameter
|month=ignored (help) - ↑ Savage DD, Garrison RJ, Castelli WP, McNamara PM, Anderson SJ, Kannel WB, Feinleib M (1983). "Prevalence of submitral (anular) calcium and its correlates in a general population-based sample (the Framingham Study)". The American Journal of Cardiology. 51 (8): 1375–8. PMID 6846165. Retrieved 2012-04-11. Unknown parameter
|month=ignored (help) - ↑ Barasch E, Gottdiener JS, Larsen EK, Chaves PH, Newman AB, Manolio TA (2006). "Clinical significance of calcification of the fibrous skeleton of the heart and aortosclerosis in community dwelling elderly. The Cardiovascular Health Study (CHS)". American Heart Journal. 151 (1): 39–47. doi:10.1016/j.ahj.2005.03.052. PMID 16368289. Retrieved 2012-04-11. Unknown parameter
|month=ignored (help) - ↑ Allison MA, Cheung P, Criqui MH, Langer RD, Wright CM (2006). "Mitral and aortic annular calcification are highly associated with systemic calcified atherosclerosis". Circulation. 113 (6): 861–6. doi:10.1161/CIRCULATIONAHA.105.552844. PMID 16461818. Retrieved 2012-04-11. Unknown parameter
|month=ignored (help) - ↑ Fox CS, Vasan RS, Parise H, Levy D, O'Donnell CJ, D'Agostino RB, Benjamin EJ (2003). "Mitral annular calcification predicts cardiovascular morbidity and mortality: the Framingham Heart Study". Circulation. 107 (11): 1492–6. PMID 12654605. Retrieved 2012-04-11. Unknown parameter
|month=ignored (help) - ↑ Ix JH, Shlipak MG, Katz R, Budoff MJ, Shavelle DM, Probstfield JL, Takasu J, Detrano R, O'Brien KD (2007). "Kidney function and aortic valve and mitral annular calcification in the Multi-Ethnic Study of Atherosclerosis (MESA)". American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 50 (3): 412–20. doi:10.1053/j.ajkd.2007.05.020. PMID 17720520. Retrieved 2012-04-10. Unknown parameter
|month=ignored (help) - ↑ Kizer JR, Wiebers DO, Whisnant JP, Galloway JM, Welty TK, Lee ET, Best LG, Resnick HE, Roman MJ, Devereux RB (2005). "Mitral annular calcification, aortic valve sclerosis, and incident stroke in adults free of clinical cardiovascular disease: the Strong Heart Study". Stroke; a Journal of Cerebral Circulation. 36 (12): 2533–7. doi:10.1161/01.STR.0000190005.09442.ad. PMID 16254219. Retrieved 2012-04-11. Unknown parameter
|month=ignored (help) - ↑ 8.0 8.1 Salem DN, O'Gara PT, Madias C, Pauker SG (2008). "Valvular and structural heart disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)". Chest. 133 (6 Suppl): 593S–629S. doi:10.1378/chest.08-0724. PMID 18574274. Retrieved 2012-04-10. Unknown parameter
|month=ignored (help)