Background and aims: The aim of this study was to investigate the prevalence of mitral annular calcification (MAC) and aortic valve calcification (AVC) according to the presence or absence of complex aortic atheroma (CAA), using transesophageal echocardiography (TEE) data.
Methods: This study included 130 (mean age 59.5 years; male 68.5%) consecutive patients who admitted in our hospital with acute ischemic stroke and underwent transesophageal echocardiography (TEE) for determination of stroke etiology during hospitalization. Stroke subtypes were classified with TOAST criteria. Embolic stroke with undetermined source (ESUS) was defined on the basis of the Cryptogenic Stroke/ESUS International Working Group criteria. MAC and AVC were defined as focal areas of high echogenicity of mitral valve annulus and aortic leaflet, respectively. CAA was assessed by TTE and defined as ≥4 mm and/or ulceration and/or mobile plaques. Comparisons were made between patients with and without CAA (CAA and non-CAA group, respectively) with regard to clinical and echocardiological findings.
Results: Of the 130 patients, 26 (20.0%) had CAA. The patients in the CAA and non-CAA groups showed significant differences in age (mean, 69.5 vs. 57.0, P < 0.001), hypertension (88.5% vs. 44.2%, P < 0.001), chronic kidney disease (46.2% vs. 22.1%, P = 0.013), diabetes mellitus (61.5% vs. 23.1%, P < 0.001), hyperlipidemia (69.2% vs. 37.5%, P = 0.004), MAC (23.1% vs. 2.9%, P < 0.001), AVC (19.2% vs. 5.8%, P = 0.022), and MAC or/and AVC (34.6% vs. 7.7%, P < 0.001). When restricted to ESUS patients, there were significant differences in age (mean, 65.0 vs. 53.3, P = 0.042), hypertension (mean, 80.0% vs. 43.6%, P = 0.040), history of coronary artery disease (40.0% vs. 2.6%, P < 0.001), diabetes mellitus (60.0% vs. 12.8%, P = 0.001), hyperlipidemia (80.0% vs. 30.8%, P = 0.004), AVC (37.5% vs. 6.8%, P = 0.012), and MAC or/and AVC (34.6% vs. 7.7%, P = 0.030) between the 2 groups, whereas the prevalence of MAC was not different between CAA and non-CCA groups (12.5% vs. 2.3%, P = 0.16).
Conclusions: Stroke patients with CAA frequently have concurrent MAC and/or AVC, which may prompt an effort to detect CAA for patients with MAC and /or AVC in transthoracic echocardiography.