DPIR contains data for all CIED implantations in Denmark. 17) The data included indication, date of implantation, and CIED type. Inter- and intra-observer variability in MAC score measurements were assessed by all 7 radiographers and a second reader (M.H.F.) in 140 randomly selected participants.ĭata regarding CIED implantation were obtained from the Danish PM and Implantable Cardioverter Defibrillator (ICD) Register (DPIR) from January 2000 to December 2018. Due to a non-normal distribution, MAC scores were divided into absent (0 Agatston unit ) versus present (≥ 1 AU) and 8 MAC score categories (0, 1–9, 10–99, 100–199, 200–299, 300–599, 600–1,199 and ≥1,200 AU) for different parts of our analysis. 9) MAC was defined as calcium deposition at the junction between the left atrium and left ventricle at the level of the mitral annulus, excluding calcium in the mitral leaflets aortic valve left main, circumflex, and right coronary artery and leads ( Figure 1). 15) Using a SyngoVia (Siemens Healthcare Solutions) workstation, 7 trained radiographers, blinded to clinical data, measured heart valve calcification scores using the Agatston method. The computed tomography (CT) specifications are provided in the supplementary material ( Supplementary Data 1) and have previously been described in detail. In addition, we assessed the association between MAC scores and traditional cardiovascular risk factors.Īll participants received a cardiac NCCT scan during their screening examination. In this large, population-based, cross-sectional study, we assessed the association between MAC scores identified using cardiac NCCT imaging and AV conduction disturbances identified by CIED implantation and electrocardiographic (ECG) parameters. 2), 9) Risk factors for MAC have previously been reported to include age, female sex, diabetes, obesity, smoking, hypertension, dyslipidemia, and renal dysfunction, 2), 10), 11), 12), 13) but most studies have used echocardiography, which is less sensitive than cardiac NCCT imaging to identify MAC. Red, MAC Yellow, coronary artery calcification Purple, Ao calcification.Īo: aortic valve, LA: left atrium, LV: left ventricle, MAC: mitral annulus calcification, RA: right atrium, RV: right ventricle.Ĭardiac non-contrast computed tomography (NCCT) imaging is currently the best modality allowing precise and reproducible quantification of MAC using the Agatston method. The bundle of His is located close to the posterior aspect of the mitral annulus and is marked with a white cross (G). 8) Therefore, studying MAC might help explain why AV conduction disturbances develop and could have potential clinical implications in the future.Ĭardiac non-contrast computed tomography images and 12-lead electrocardiography from a patient with MAC (MAC score = 7,154 Agatston unit) and a prolonged QRS-interval (146 ms). The development of acquired AV conduction disturbances is poorly understood, with idiopathic degeneration of the cardiac conduction system being the most common cause. 7) Overall, this potential association remains poorly investigated, and the association between MAC and the need for other types of CIED has not been studied. In some publications, MAC has been associated with AV conduction disturbances and pacemaker (PM) implantation, 3), 4), 5), 6) but not all studies agree. 2) In that case, MAC might be a predictor of AV conduction disturbances that require the use of a cardiac implantable electronic device (CIED) but not of CIED implantation in general. 1) Due to the anatomical location of MAC, very close to the AV-node and bundle of His ( Figure 1), it has been hypothesized that MAC could be associated with atrioventricular (AV) conduction disturbances. 1) MAC is a common finding, with a prevalence of 5–42% depending on the age and sex of the examined population and the modality used to identify MAC. Mitral annulus calcification (MAC) is defined as calcium deposition at the base of the mitral valve, typically in the posterior aspect.
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