Mitral Valve Calcification Research Articles

Osteogenesis inducers promote distinct biological responses in aortic and mitral valve interstitial cells.

Both aortic and mitral valves calcify in pathological conditions; however, the prevalence of aortic valve calcification is high whereas mitral valve leaflet calcification is somewhat rare. Patterns of valvular calcification may differ due to valvular architecture, but little is known to that effect. In this study, we investigated the intrinsic osteogenic differentiation potential of aortic versus mitral valve interstitial cells provided minimal differentiation conditions. For the assessment of calcification at the cellular level, we used classic inducers of osteogenesis in stem cells: β-glycerophosphate (β-Gly), dexamethasone (Dex), and ascorbate (Asc). In addition to proteomic analyses, osteogenic markers and calcium precipitates were evaluated across treatments of aortic and mitral valve cells. The combination of β-Gly, Asc, and Dex induced aortic valve interstitial cells to synthesize extracellular matrix, overexpress osteoblastic markers, and deposit calcium. However, no strong evidence showed the calcification of mitral valve interstitial cells. Mitral cells mainly responded to Asc and Dex by cell activation. These findings provide a deeper understanding of the physiological properties of aortic and mitral valves and tendencies for calcific changes within each valve type, contributing to the development of future therapeutics for heart valve diseases.

Differential expression patterns of Toll Like Receptors and Interleukin-37 between calcific aortic and mitral valve cusps in humans

BackgroundSignificant differences are mentioned in the progress of calcification between aortic and mitral valve. Evidence of inflammation in calcific aortic and mitral valve disease suggests that pathways of Toll Like Receptors (TLR) and Interleukin (IL)-37 expression may contribute to this process. We sought to investigate the role of TLR-mediated inflammatory response and IL-37 pathway expression on aortic and mitral valve calcification. Material and methodsOne-hundred twenty stenotic valve cusps/leaflets (60 aortic, 60 mitral) were excised during surgery and were collected for histological, immunohistochemistry and morphometric analysis at our department. After total RNA isolation from a second part of valve cusps/leaflets, cDNA synthesis and quantitative reverse transcription polymerase chain reaction (qRT-PCR) protocols were performed and relative mRNA levels of target genes were assessed. ResultsBy histological analysis, the anti-inflammatory IL-37 levels were increased in mitral valve leaflets (MVL) compared to aortic valve cusps (AVCu) while all other biomarkers, including TLR, presented a reverse pattern with decreased levels as compared to AVCu. In terms of calcification biomarkers, only osteopontin differed between AVCu and MVL. mRNA analysis confirmed increased expression of IL-37 and decreased levels of TLR in MVL compared to AVCu. ConclusionsStenotic cusps of aortic valves express lower IL-37 and increased TLRs levels than stenotic mitral valve leaflets, suggesting a differential pro-calcification and pro-inflammatory profile between the two valves. This may explain the higher incidence of calcification of AVCu than MVL and offer therapeutic considerations.

De novo Cardiac Valve Calcification after Hemodialysis in End-Stage Renal Disease Patients Predicts Future Cardiovascular Events: A Longitudinal Cohort Study

Background: Cardiac valve calcification (CVC) in maintenance hemodialysis patients is associated with adverse cardiovascular outcomes. However, whether de novo CVC in incident hemodialysis patients predicts future cardiovascular events is unknown. Methods: This study included 174 patients newly receiving hemodialysis without CVC as reflected by echocardiography between January 2005 and December 2014. De novo CVC was determined with echocardiography once every 6 months until December 2016. Results: The median follow-up was 66 months (range, 19–141). De novo CVC developed in 80 out of 174 (45.98%) subjects: 58 developed aortic valve calcification (AVC) alone, 42 developed mitral valve calcification (MVC) alone, and 20 developed both AVC and MVC. The median time from baseline to de novo CVC was 46 months (range, 3–120) for AVC and 50 months (range, 13–127) for MVC. Patients who developed CVC had a higher major adverse cardiovascular events (MACE) rate than those who did not (AVC: 30/58 [51.72%] vs. 23/116 [19.83%]; MVC: 25/42 [59.52%] vs. 28/132 [21.21%]). Multivariate time-dependent Cox regression showed an association between MACE with both de novo AVC and MVC (AVC: hazard ratio [HR] 3.2, 95% confidence interval [CI] 1.55–6.63; MVC: HR 5.95, 95% CI 2.90–12.20). Conclusions: De novo CVC is an independent risk factor for MACE in hemodialysis patients, and regular CVC screening among hemodialysis patients without preexisting CVC may be helpful to identify patients at increased risk of adverse cardiovascular outcomes.

Reconstructive surgery of an extremely calcified mitral valve in Barlow disease patient: A case report

Introduction: Mitral valve calcifications are frequent finding in the Barlow disease. This is makinkg mitral repair surgery even more demanding in already complex valve pathology. Case report: Fifty-five year old Barlow disease patient underwent mitral repair surgery due to posterior leaflet prolapse at P2 level and extensive posterior leaflet and annular calcifications as well. Prolapsed scalop was resected, while P1 and P3 scalops were detached from the annulus. After complete posterior annulus decalcification, so formedlarge atrio-ventricular defect was reconstructed with autologous pericardial patch and double suture line technique.P1 and P3 segments were reatched thereafter by sliding technique, and sutured with no strain. Annuloplasty was performed with saddle rigid ring No 36. Patient was discharged nine days after the surgery with just a trace of mitral reguritation. Conclusion: Annular decalcificaion and reconstruction in patients with calcified Barlow mitral disease is neccessary for safe and durable mitral valve repair surgery.

Cor triatriatum with mitral stenosis: A diagnostic dilemma

Cor triatriatum sinister is an extremely rare congenital heart defect. Very few cases have been reported for cor triatriatum associated with mitral regurgitation. We are reporting an exceptional case of cor triatriatum associated with calcified mitral valve resulting mitral stenosis. Preoperatively, mitral stenosis was underestimated due to the presence of restricted communication between two chambers of the left atrium. The patient was operated for cor triatriatum repair with mitral valve replacement.

Cardiac valve calcification and use of anticoagulants: Preliminary observation of a potentially modifiable risk factor

AimsDirect oral anticoagulant (DOAC) has been recently introduced in the clinical practice. Rather than interfering with vitamin K-dependent posttranscriptional modification of various proteins, DOACs selectively inhibit factors involved in the coagulation cascade. In particular, in contrast with Warfarin, Rivaroxabn does not interfere with activation of matrix Gla Protein (MGP), a potent vascular calcification Inhibitor. We herein sought to investigate the impact of Rivaroxaban and Warfarin on cardiac valve calcifications in a cohort of moderate-to advanced CKD patients. Methods and resultsThis is a multicenter, observational, retrospective, longitudinal study. Consecutive CKD stage 3b – 4 (according to KDIGO guidelines) patients from 8 cardiologic outpatient clinics were enrolled between May 2015 and October 2017. All patients received anticoagulation (100 Warfarin vs 247 Rivaroxaban) as part of their non-valvular atrial fibrillation management. Cardiac valve calcification was evaluated via standard trans-thoracic echocardiogram. 347 patients (mean age: 66 years; mean eGFR: 37 ml/min/1.73 m2) were studied. Over a mean follow-up period of 16 months, Rivaroxaban compared to Warfarin reduced both mitral and aortic valve calcifications (p < 0.001) independently of the degree of calcifications at baseline and potential confounders. Notably, Rivaroxaban use was also associated with a significant reduction in C reactive protein (CRP) (p < 0.001) during follow-up. ConclusionThis study generates the hypothesis that the use of Rivaroxaban associates with a reduction of cardiac valve calcification deposition and progression as compared to Warfarin, in a cohort of CKD stage 3b-4 patients. Future endeavors are needed to confirm and to establish the mechanisms responsible for these findings.

The presbycardia phenotype: Cardiac remodeling and valvular degeneration in nonagenarians

Nonagenarians (NON) are a growing segment of the population and have a high prevalence of cardiac disease. Many findings encountered on their echocardiograms are also found in younger individuals with valvular or myocardial disease. Therefore, the purpose of this study was to describe this distinct echocardiographic phenotype. We identified our study population by querying our echo database to identify unique septuagenarians (SEPT) and nonagenarians (NON) who underwent a transthoracic echocardiogram (TTE) from January 1, 2010 to December 31, 2014. Exclusion criteria were LVEF<50%, any akinetic wall segment, aortic stenosis, moderate-severe AR and/or severe MR, coronary revascularization within 60days of study echo, and prior valve surgery. The mean age of SEPT was 73.0±2.0 and NON was 92.0±2.1 (P<0.001). There was no gender difference between groups. NON had significantly smaller LV end-diastolic diameters than SEPT (41.6±5.7mm vs 48.0±7.0mm, P<0.001). NON had a greater relative wall thickness (0.51±0.10 vs 0.40±0.08, P<0.001) and more frequently had concentric remodeling or hypertrophy. NON had higher E/Ea ratios and estimated LA pressures (P<0.01). 48% of NON had moderate-severe mitral annular calcification compared to 25.0% of SEPT (P<0.01). Herein, we provide the first comprehensive echocardiographic description of 'presbycardia'; concentric LVH, asymmetric septal hypertrophy, mitral and aortic valve calcification, and increased epicardial fat thickness. This pattern of findings may be increasingly seen as the population ages.

Does Mitral Valve Calcium in Patients Undergoing Mitral Valve Replacement Portend Worse Survival?

Mitral annular calcification (MAC) is associated with worse outcomes after mitral valve replacement (MVR). With limited data available on long-term outcomes, we reviewed our experience of MVR in presence of MAC. A retrospective review of 1,710 consecutive patients who underwent MVR between January 2000 and December 2015 was performed. Patients with isolated primary MVR (n= 496) were included, whereas patients with concomitant cardiac surgery (n= 1,068), previous MVR (n= 110), and mitral valve (MV) endocarditis (n= 36) were excluded. MV calcification was classified as MAC present in anterior/posterior annulus and vertically at the level of leaflets/subvalvular apparatus. A conservative approach towards annular debridement was followed. Our sample's mean age was 64.4 ± 14.1 years, and included 279 (56%) women. MV calcification was observed in 169 (34%) patients with MAC in 115 (23%). Older age, higher ejection fraction, peripheral vascular disease, diabetes, dialysis, and previous aortic valve surgery were associated with increased prevalence of MAC. Patients with MV calcification had higher stroke rate (p= 0.040), patients with anterior leaflet and commissural calcification had higher pacemaker implantation (p= 0.010, p= 0.001, respectively), and patients with circumferential MAC had higher postoperative dialysis (p= 0.006). Operative mortality was not significantly different (p= 0.466) between MAC (n= 1, 1%) and non-MAC (n= 9, 2%) patients. MAC was associated with late mortality (unadjusted hazard ratio, 1.62; 95% confidence interval, 1.20 to 2.18), though on multivariable analysis age, diabetes, dialysis, hypertension, previous aortic valve surgery, previous coronary artery bypass grafting, and MVR with a bioprosthetic valve were found to be independent risk factors for mortality whereas MAC was not. A conservative approach to treat MAC achieves satisfactory results. Patients with MAC have significant comorbidities contributing to a worse survival, though MAC in itself is not a risk factor for mortality.

Association of matrix metalloproteinase 3 and endogenous inhibitors with inflammatory markers in mitral valve disease and calcification.

Calcific mitral valve stenosis (MVS) is a common disease characterized by extensive remodeling of the extracellular matrix via matrix metalloproteinases (MMPs). The mechanism of calcification due to extensive matrix remodeling remains unclear. In this study, we investigated the relationship between MMP-3, tissue inhibitors of metalloproteinases (TIMPs) as well as pro-inflammatory cytokines and the phenomenon of calcification in MVS. 212 patients having rheumatic mitral stenosis (RMS) and 155 healthy control subjects were recruited in the Cardiology Department of La Rabta Hospital University. Levels of MMP-3, TIMPs, IL-6 and TNF-α were measured by ELISA sandwich assay, hs-CRP was measured by immunoturbidimetry. Plasma levels of MMP-3, TIMP-1 and MMP-3/TIMP-2 ratio were lower only in RMS women in comparison to the control group. Calcification degree correlated positively with MMP-3 in women and men. In addition, calcification was correlated positively with MMP-3/TIMPs ratio in women patients. The inflammatory parameters were positively associated with extracellular matrix turnover biomarkers in men patients. In patients, the level of MMP-3 was increased in men and women with a calcification score ≥ 5. In addition, MMP-3 level predicted the occurrence of calcification. At ROC curves analysis, the cut-off MMP-3 level was in women was 9.21ng/ml (sensitivity 51.1%, specificity 89.3%) and in men was 12.84ng/ml (sensitivity 78.6%, specificity 77.8%). The high levels of MMP-3 and the biomarkers of inflammation contribute to valvular remodeling and calcification of the mitral valve.

LEFT HEART DIASTOLIC DYSFUNCTION PARAMETERS IN ASSOCIATION WITH PULMONARY FUNCTION VARIABLES IN COPD

SESSION TITLE: Obstructive Lung Diseases 2 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: COPD is a leading cause for morbidity and mortality worldwide. Though it is primarily a pulmonary disease, COPD affects other body systems including the cardiovascular system. Few studies have found an association between COPD and left heart diastolic dysfunction. The aim of this study is to look for an association between parameters of diastolic dysfunction, and parameters of pulmonary function test (PFT) among patients with COPD. METHODS: This is a cross-sectional analysis performed in a community-based teaching hospital. Patients with working diagnosis of COPD, who underwent PFT during the years 2016 and 2017, were initially-screened. A total of 182 individuals were identified. We then included the patients who had; 1) forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) ratio < 70%, and 2) an echocardiography performed not more than two years from the most recent PFT. Patients were excluded if any one of the following was identified; 1) age < 18 years old, 2) mitral stenosis, repair, or replacement, 3) moderate annular mitral valve calcification or worse, 4) moderately severe mitral regurgitation or worse, 5) left ventricular assistant device, 6) left bundle branch block, 7) ventricular-paced rhythm, 8) ejection fraction (EF) < 50%. We included the following cardiac variables; EF, tricuspid regurgitation (TR) velocity, average e/e’, septal e’, and lateral e’. PFT variables (as percentage predicted) were; post-bronchodilator FEV1, post-bronchodilator FVC, total lung capacity (TLC), residual volume (RV), and functional residual capacity (FRC). Correlation between each cardiac parameter and each PFT variable was estimated using Pearson correlation coefficient. Two-tailed t-test was used to calculate p-values. RESULTS: From the 182 initially-screened individuals, a total of 24 were identified. 66.7% (n=16) were females, and with mean age of 66.2 ± 8.2 years. After performing statistical analysis, there was a significant association between FRC and TR velocity with correlation coefficient of 0.44 (p =0.033). Moreover, there was a trend, but not a significant association, between RV and TR velocity with correlation coefficient of 0.38 (p = 0.067). CONCLUSIONS: Among patients with COPD, FRC and RV, parameters for air-trapping, are associated with TR velocity, a parameter for diastolic dysfunction. CLINICAL IMPLICATIONS: One of the theories which attempts to explain left heart diastolic dysfunction in patients with COPD is that auto-PEEP effect due to air-trapping would cause reduction in preload, which then stresses the left ventricle, leading to tachycardia with subsequent diastolic dysfunction. In our study, the association between FRC and TR velocity, along with the trend between RV and TR velocity would support this theory. This could help in predicting patients with COPD who might have unidentified left heart diastolic dysfunction. DISCLOSURES: No relevant relationships by Ali Alkhayat, source=Web Response No relevant relationships by Faeq Kukhon, source=Web Response No relevant relationships by Taro Minami, source=Web Response No relevant relationships by Ahmed Mohamed, source=Web Response No relevant relationships by Fatima Zeba, source=Web Response

Prevalence and Prognostic Implications of Mitral and Aortic Valve Calcium in Patients With Chronic Kidney Disease

Calcium in the cardiac valves can be observed in patients with severe chronic kidney disease (CKD). However, the prevalence and prognostic implications of left-sided cardiac valve calcium in patients with stage 2 and 3 CKD (estimated glomerular filtration rate (eGFR) of 60 to 89 and 30 to 59 ml/min/1.73 m² respectively) is unknown. The present study investigates the prevalence of mitral and aortic valve calcium in patients with stage 2 and 3 CKD and evaluates its association with all-cause mortality. In patients with stage 2 and 3 CKD who underwent clinically indicated coronary computed tomography angiography, the presence of mitral and/or aortic valve calcium was assessed. Patients were divided into 2 groups according to the presence of mitral and/or aortic valve calcium on coronary computed tomography angiography. Patients were followed for the occurrence of all-cause mortality (primary end point). Of 204 stage 2 and 3 CKD patients (54% men, mean age 60 ± 10 years), 66 (32%) patients had mitral and/or aortic valve calcium. During a median follow-up of 6 years (IQR; 2, 9 years), 29 (14%) patients died. Patients with mitral and/or aortic valve calcium showed significantly higher mortality rates compared with patients without left-sided valve calcium (log-rank p = 0.009). Mitral valve calcium was independently associated with increased risk of all-cause mortality, whereas aortic valve calcium was not. In conclusion, the prevalence of left-sided valve calcium in patients with stage 2 and 3 CKD is high. Mitral valve calcium was independently associated with increased risk of all-cause mortality, whereas aortic valve calcium was not.

Risk factors for heart valve calcification in chronic kidney disease

Cardiovascular disease (CVD) is a common cause of death in patients with chronic kidney disease (CKD). Aortic and mitral valve calcification (AVC and MVC, respectively) are critical indicators of CVD and all-cause mortality in CKD patients.We conducted a single center retrospective study of Chinese inpatients with CKD to identify risk factors associated with valve calcification (VC).Of 288 enrolled CKD patients, 22.9% had VC, all of which exhibited AVC, while 21.2% exhibited MVC. The VC group were significantly older than the non-VC group (70.42 ± 11.83 vs 56.47 ± 15.00, P < .001), and contained more patients with history of coronary artery disease (12.1% vs 4.5%, P = .025) or stroke (18.2% vs 5.4%, P < .001). Subjective global assessment scoring indicated that more VC patients were mid/severely malnourished. Levels of prealbumin, cholesterol (Ch), triglycerides, low-density lipoprotein (LDL), apolipoprotein E, ejection fraction, and fraction shortening were significantly lower, and blood C reactive protein, IL-6, left ventricular internal end diastole diameter measured in end diastole, and interventricular septum thickness (IVST) levels were significantly higher in the VC group. Bone metabolism did not differ significantly between the 2 groups. Multivariable logistic regression analysis indicated that age, blood Ch, and LDL levels were significantly associated with VC.Advanced age, increased IVST, hypocholesterolemia, and hyper-LDL cholesterolemia were key risk factors for VC in Han patients with CKD.

TWENTY YEARS EXPERIENCE OF SUCCESSFUL PERCUTANEOUS TRANSMITRAL COMMISUROTOMY PERFORMED THROUGH PATENT FORAMEN OVALE

Objective: To assess the efficacy and effectiveness of PTMC through patentforamen ovale in patients with symptomatic mitral stenosis. Methodology: This cross sectional study included patients with symptomaticmitral stenosis from January 1995 to December 2016, at Lady Readng Hospital,Cardiology Department. All patients were subjected to detailed clinicalexamination. BLIs were performed. (TTE and TEE) wasperformed to exclude LA/LAA clot, to assess the calcification of mitral valve andcheck the anatomy of inter ventricular septum. Patients with severely calcifiedmitral valve and with +2 mitral regurgitation were excluded. PFO was crossed inmajority of cases to reach LA. Mitral valve stenosis was relieved with Inoueballoon. Result: Total number of patients enrolled was 3751. Females were 76%. Themean age was 27.5± 7.2 years. Mean BMI was 19.8±2.1 kg/m . PTMC of92.08% patients was performed through PFO. Mean valve area was 0.9±0.21cm on 2D echocardiography, which was successfully dilated upto 1.82±0.17cm (p>0.05). Mitral valve gradient decreased from18 ± 4.08 mm of Hg to7.0 ± 0.25 mm of Hg (p 0.05). Abandonment rate of PTMC through PFO was quiteless 0.57% as compared to PTMC through septal puncture 2.69%. Conclusion: PTMC through PFO is effective, safe and user friendly procedurewith fewer complication rates. Key Words: Percutaneous transmitral commisurotomy, Patent foramen ovale,Transesophageal echocardiography, Transthoracic echocardiography, Leftatrium.222EchocardiographyPak Heart

Relation of wnt-signaling antagonist sclerostin to valvular calcification and carotid intimal-medial thickness in hemodialysis patients

Introduction Sclerostin (Scl) is a Wnt pathway antagonist and is considered to have a role in the bone-vascular axis in patients with chronic kidney disease. However, there is a paucity of data on the relation of circulating serum Scl and valvular calcifications (VCs) in chronic kidney disease and hemodialysis (HD) patients. The present study aimed to evaluate the relationship between serum Scl level and cardiac valve calcification (CVC) as well as carotid intimal-medial thickness (CIMT) in HD patients. Patients and methods This cross-sectional study included 75 HD patients in Mansoura Nephrology and Dialysis Unit. Patients with age older than 75 years, rheumatic valvular disease, cardiomyopathy, prosthetic valves, ischemic heart disease, and carotid artery surgery were excluded. Echocardiogram calcification scores were used to assess the degree of aortic and mitral valve calcification. CIMT was measured using B-mode ultrasonography. Patients’ basic clinical and biochemical data were recorded. Serum Scl level was measured using commercially available enzyme-linked immunosorbent assay kits before HD sessions. Results CIMT (>0.9 mm) was present in 68% of the patients. Double-valve calcification (aortic and mitral) was present in 72% of the patients and 21.3% of the patients had single-valve calcification. Serum Scl level was significantly higher in studied HD patients than normal healthy control (P=0.05). There was a significant negative correlation between serum Scl level and degree of cardiac valve calcification as well as with CIMT. Multiple linear regression analysis revealed that age was the strongest predictor for CIMT in HD patients. Conclusion Cardiac valve calcification and increased CIMT were prevalent in HD patients. Serum Scl level was strongly related to both CVC and CIMT, and it may be considered as one of the calcification modulators in HD patients.

Transcatheter Mitral Valve Implantation in Open Heart Surgery: An Off-Label Technique

Extensive mitral annulus calcifications are considered a contraindication for valve surgery. We describe the case of a 76-year-old female with severe mitral and aortic stenosis associated with extensive calcifications of the heart. The patient underwent an open mitroaortic valve replacement using transcatheter aortic valve implantation with an Edwards SAPIEN XT valve (Edwards Lifesciences Corp., Irvine, CA, USA) in the mitral position. The aortic valve was replaced using a stentless valve prosthesis (LivaNova SOLO; LivaNova PLC, London, UK). Postoperative echocardiography showed that the prosthetic valve was in the correct position and there were no paravalvular leaks. A bailout open transcatheter valve implantation can be considered a safe and effective option in selected cases with an extensively calcified mitral valve.

Associations of Mitral and Aortic Valve Calcifications with Complex Aortic Atheroma in Patients with Embolic Stroke of Undetermined Source

This study investigated the associations of mitral and aortic valve calcification with complex aortic atheroma among patients with embolic stroke of undetermined source. We included 52 consecutive patients (mean age 58.1 years; 75.0% male) with embolic stroke of undetermined source. Mitral annular calcification, aortic annular calcification, and aortic valve sclerosis were assessed by transthoracic echocardiography. Complex aortic atheroma was assessed by transesophageal echocardiography and was defined as plaque protruding greater than or equal to 4 mm into the lumen or with ulcerated or mobile components. Ten patients (19.2%) had complex aortic atheroma. Patients with and without complex aortic atheroma showed significant differences in terms of hypertension (80.0% versus 38.1%, P = .017), dyslipidemia (90.0% versus 31.0%, P <.01), chronic kidney disease (60.0% versus 14.3%, P <.01), previous coronary artery disease (30.0% versus 4.8%, P = .013), prior stroke (40.0% versus 7.1%, P <.01), left atrial dimension (4.0 cm versus 3.6 cm, P = .023), aortic valve sclerosis (80.0% versus 26.2%, P <.01), aortic valve calcification (aortic annular calcification or aortic valve sclerosis) (80.0% versus 26.0%, P <.01), and left-sided valve calcification (mitral annular calcification or aortic annular calcification or aortic valve sclerosis) (80.0% versus 28.6%, P <.01). In multivariate analysis, left-sided valve calcification was independently associated with complex aortic atheroma (odds ratio 4.1, 95% confidence interval 1.3-26.1, P = .049). Mitral or aortic valve calcification detected by transthoracic echocardiography can be a useful marker for predicting complex aortic atheroma in patients with embolic stroke of undetermined source.

Automatic Calcium Scoring in Low-Dose Chest CT Using Deep Neural Networks With Dilated Convolutions.

Heavy smokers undergoing screening with low-dose chest CT are affected by cardiovascular disease as much as by lung cancer. Low-dose chest CT scans acquired in screening enable quantification of atherosclerotic calcifications and thus enable identification of subjects at increased cardiovascular risk. This paper presents a method for automatic detection of coronary artery, thoracic aorta, and cardiac valve calcifications in low-dose chest CT using two consecutive convolutional neural networks. The first network identifies and labels potential calcifications according to their anatomical location and the second network identifies true calcifications among the detected candidates. This method was trained and evaluated on a set of 1744 CT scans from the National Lung Screening Trial. To determine whether any reconstruction or only images reconstructed with soft tissue filters can be used for calcification detection, we evaluated the method on soft and medium/sharp filter reconstructions separately. On soft filter reconstructions, the method achieved F1 scores of 0.89, 0.89, 0.67, and 0.55 for coronary artery, thoracic aorta, aortic valve, and mitral valve calcifications, respectively. On sharp filter reconstructions, the F1 scores were 0.84, 0.81, 0.64, and 0.66, respectively. Linearly weighted kappa coefficients for risk category assignment based on per subject coronary artery calcium were 0.91 and 0.90 for soft and sharp filter reconstructions, respectively. These results demonstrate that the presented method enables reliable automatic cardiovascular risk assessment in all low-dose chest CT scans acquired for lung cancer screening.

Circulating level and tissue distribution of sclerostin in calcified mitral valves of rheumatic heart disease

Circulating level and tissue distribution of sclerostin in calcified mitral valves of rheumatic heart disease

Relationship of Aortic Wall Distensibility to Mitral and Aortic Valve Calcification: The Multi-Ethnic Study of Atherosclerosis.

Data are limited on whether valvular calcification is associated with aortic wall stiffness. We tested whether aortic valve calcification (AVC) and/or mitral valve calcification (MVC) is inversely associated with aortic distensibility (AD). Cross-sectional study conducted in a subset of the Multi-Ethnic Study of Atherosclerosis (MESA) included 3676 MESA participants aged 44 to 84 years with AD measured with magnetic resonance imaging and with AVC and MVC measured with noncontrast cardiac computed tomography scans. Both AVC and MVC were divided into 3 categories: zero, < median values (low), and ≥ median values (high) for patients with nonzero values. Overall, 88% (n = 3256) and 92% (n = 3365) of participants had zero AVC and MVC, while 6% (n = 211) and 4% (n = 156) had low, and 6% (n = 209) and 4% (n = 155) had high values of AVC and MVC, respectively. The AVC was independently associated with AD after adjusting for age, gender, and ethnicity ( P = .035). No association was noted between AVC groups and AD after adjustment for all covariates or MVC groups and AD in any model.

Serowate włóknienie pierścienia zastawki mitralnej — groźny wygląd, łagodny charakter*

Caseous calcification of the mitral annulus (CCMA) is a rare form of mitral valve calcification. We present a 82-year-old female patient, who was hospitalized due to heart failure symptoms and atrial fibrillation with heart rate 180/min. Echocardiography revealed a round mass attached to annulus and posterior leaflet of mitral valve. Based on the multimodal diagnostics: transoesophageal echocardiography, computed tomography and magnetic resonance imaging, CCMA was diagnosed. The improvement of the general state and conversion to sinus rhythm was achieved with pharmacotherapy. The patient was excluded from surgery, and qualified for periodic echocardiographic control.