Serum Fetuin-A and Mitral Annular Calcification As a New Predictors For Significant Coronary Artery Disease

Abstract

Mitral annular calcification has been shown to be associated with atherosclerosis,and is a predictor of cardiovascular events. Fetuin-A has recently been described as aserum-based inhibitor of calcification. The present study was designed to evaluate thepredictive value of serum fetuin-A and mitral annular calcification in patients withsuspected/ diagnosed coronary artery disease. We prospectively studied fifty fourpatients with suspected/diagnosed coronary artery disease without renal impairmentor rheumatic valvular disease. The patients divided into 3 groups according to fetuin-A values. Group 1 low fetuin-A (32 patients). Group 2 normal fetuin-A (12 patients),group 3 fetuin-A high fetuin-A (10 patients). Full clinical examination, transthoracicechocardiography, coronary angiography, biochemical investigations offered to allpatients and fetuin-A level measured using EDI human fetuin-A ELISA kit. The resultsof the current study showed a higher incidence of mitral annular calcification amonggroup 1 (59.4%) in comparison to other groups, on other hand the same group hadlower left ventricular ejection fraction percent and higher incidence of restingregional wall motion abnormalities. Angiography showed a higher prevalence ofsevere coronary artery disease in patients with mitral annular calcification than thosewithout. Group 1 had, also higher prevalence of left main stenosis (43.1%vs 0%)P<0.05, and triple vessels disease (43.6%vs 13%) P<0.05. While the predictiveability of Mitral annular calcification in detection of significant coronary arterydisease was highly significant P= 0.0001. There was significant negative correlationbetween fetuin-A and hsCRP p<0.01and LDL-c p<0.05. One of the main findings isthe inverse association of serum fetuin-A concentration with Mitral annularcalcification as well as strong predictive value of both to presence of significantcoronary artery disease after multilogestic regression analysis. Conclusion: insymptomatic patients with suspected coronary artery disease, the presence of lowfetuin-A level and mitral annular calcification, may be considered as independentpredictors for the presence of significant obstructive coronary artery disease.