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      Mitral annular calcification is associated with atrial fibrillation and major cardiac adverse events in atrial fibrillation patients : A systematic review and meta-analysis

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          Abstract

          Supplemental Digital Content is available in the text

          Abstract

          Background:

          The incidence of atrial fibrillation (AF) varies from 5.4% to 47.1% in patients with mitral annulus calcification (MAC). We conducted a systematic review and meta-analysis on the association between MAC and AF, as well as the relation between MAC and major cardiac adverse events (MACEs) in AF patients.

          Methods:

          We conducted comprehensive search for literature on associations between MAC and AF using the following databases: MEDLINE, PubMed, Embase, and the Web of Science. The pooled odds ratio (OR) or relative risk and the corresponding 95% confidence intervals (CIs) were calculated to assess the relationship between MAC and AF, as well as the rates of MACEs in AF patients with or without MAC.

          Results:

          Thirteen studies met our eligibility criteria on associations between MAC and AF, including 6232 patients with MAC and 15,199 patients without MAC. Moreover, 5 studies met our eligibility criteria on the rates of MACEs in AF patients with or without MAC. The pooled analysis demonstrated a statistically significant increased risk of development of incident AF in patients with MAC than those without MAC (random effects OR: 2.34; 95% CI: 1.91, 2.85; P = .000). And the pooled analysis demonstrated a statistically significant increased risk of development of MACEs in AF patients with MAC (random effects OR: 2.34; 95% CI: 1.24, 4.41; P = .009).

          Conclusion:

          MAC was independently associated with AF and AF patients with MAC were at greater risk for cardiovascular and cerebrovascular events.

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          Most cited references32

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          2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.

          Valentin Fuster, Lars E Rydén, Davis Cannom … (2011)
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            Population prevalence, incidence, and predictors of atrial fibrillation in the Renfrew/Paisley study.

            D Hole, Stephen C. Hart, Rebecca McMurray … (2001)
            Though atrial fibrillation (AF) is an important cause of cardiovascular morbidity, there are few large epidemiological studies of its prevalence, incidence, and risk factors. The epidemiological features of AF are described in one of the largest population cohorts ever studied. The prevalence and incidence of AF were studied in the Renfrew/Paisley population cohort of 15 406 men and women aged 45-64 years living in the west of Scotland. This cohort was initially screened between 1972 and 1976 and again between 1977 and 1979. Incident hospitalisations with AF in the 20 year period following initial screening were also studied. The population prevalence of AF in this cohort was 6.5 cases/1000 examinations. Prevalence was higher in men and older subjects. In those who were rescreened, the four year incidence of AF was 0.54 cases/1000 person years. Radiological cardiomegaly was the most powerful predictor of new AF (adjusted odds ratio 14.0). During 20 year follow up, 3.5% of this cohort was discharged from hospital with a diagnosis of AF; the rate of incident hospitalisation for AF was 1.9 cases/1000 person years. Radiological cardiomegaly (adjusted odds ratio 1.46) and systolic blood pressure (adjusted odds ratio 2.1 for >/= 169 mm Hg) were independent predictors of this outcome. Data from one of the largest epidemiological studies ever undertaken confirm that AF has a large population prevalence and incidence, even in middle aged people. More important, it was shown that the long term incidence of hospitalisation related to AF is high and that two simple clinical measurements are highly predictive of incident AF. These findings have important implications for the prevention of AF.
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              Mitral Annulus Calcification.

              Michael J Mack, Tarun Chakravarty, Hasan Jilaihawi … (2015)
              Mitral annulus calcification (MAC) is a chronic, degenerative process in the fibrous base of the mitral valve. Although MAC was initially thought to be an age-related degenerative process, there is accumulating evidence that other mechanisms, such as atherosclerosis and abnormal calcium-phosphorus metabolism, also contribute to the development of MAC. Despite its frequency, the clinical relevance of MAC is grossly underappreciated. Indeed, MAC is associated with an increased incidence of cardiovascular disease, mitral valve disease, arrhythmias, and mortality. MAC also influences the outcomes of cardiac surgery and interventions, and its clinical relevance may well increase substantially in the forthcoming era of transcatheter mitral valve replacement. In this paper, we review the available published data to provide a consistent, clinically relevant description of MAC on the basis of contemporary imaging. We describe the pathophysiological mechanisms contributing to the formation of MAC and the clinical implications of this disease entity.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Medicine (Baltimore)
                Journal ID (iso-abbrev): Medicine (Baltimore)
                Journal ID (publisher-id): MEDI
                Title: Medicine
                Publisher: Wolters Kluwer Health
                ISSN (Print): 0025-7974
                ISSN (Electronic): 1536-5964
                Publication date Collection: November 2019
                Publication date (Electronic): 01 November 2019
                Volume: 98
                Issue: 44
                Electronic Location Identifier: e17548
                Affiliations
                [a ]Department of Cardiology, Second Affiliated Hospital of Nanchang University, Nanchang
                [b ]Department of Cardiology, Affiliated Brain Hospital of Nanjing Medical University (Chest Branch), Nanjing, China.
                Author notes
                [∗ ]Correspondence: Qinghua Wu, Department of Cardiology, Second Affiliated Hospital of Nanchang University, Nanchang 330006, China (e-mail: ncwqh@ 123456163.com ); Jin Huang, Department of Cardiology, Affiliated Brain Hospital of Nanjing Medical University (Chest Branch), Nanjing 210029, China (e-mail: huangjin6310@ 123456sina.com ).
                Article
                Publisher ID: MD-D-19-02415 Accession ID: 17548
                DOI: 10.1097/MD.0000000000017548
                PMC ID: 6946188
                PubMed ID: 31689756
                SO-VID: dbf2de1e-81a3-4c57-a8c2-4e5c956d5721
                Copyright © Copyright © 2019 the Author(s). Published by Wolters Kluwer Health, Inc.
                License:

                This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

                History
                Date received : 25 March 2019
                Date revision received : 23 July 2019
                Date accepted : 18 September 2019
                Categories
                Subject: 3400
                Subject: Research Article
                Subject: Systematic Review and Meta-Analysis
                Custom metadata
                OPEN-ACCESS TRUE

                Keywords: atrial fibrillation,major cardiac adverse events,meta-analysis,mitral annulus calcification
                Data availability:
                Keywords: atrial fibrillation, major cardiac adverse events, meta-analysis, mitral annulus calcification

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