Mitral Annulus Calcification and Cardiac Conduction Disturbances: A DANCAVAS Sub-study

Jeppe Holm Rasmussen; Maise Hoeigaard Fredgart; Jes Sanddal Lindholt; Jens Brock Johansen; Niels Sandgaard; Abdulrahman Haj Yousef; Selma Hasific; Pernille Sønderskov; Flemming Hald Steffensen; Lars Frost; Jess Lambrechtsen; Marek Karon; Martin Busk; Grazina Urbonaviciene; Kenneth Egstrup; Axel Cosmus Pyndt Diederichsen

doi:10.4250/jcvi.2021.0110

Mitral Annulus Calcification and Cardiac Conduction Disturbances: A DANCAVAS Sub-study

J Cardiovasc Imaging. 2022 Jan;30(1):62-75. doi: 10.4250/jcvi.2021.0110.

Authors

Jeppe Holm Rasmussen^{1

2}, Maise Hoeigaard Fredgart¹, Jes Sanddal Lindholt³, Jens Brock Johansen¹, Niels Sandgaard¹, Abdulrahman Haj Yousef¹, Selma Hasific¹, Pernille Sønderskov¹, Flemming Hald Steffensen⁴, Lars Frost⁵, Jess Lambrechtsen⁶, Marek Karon⁷, Martin Busk⁴, Grazina Urbonaviciene⁵, Kenneth Egstrup⁶, Axel Cosmus Pyndt Diederichsen¹

Affiliations

¹ Department of Cardiology, Odense University Hospital, Odense, Denmark.
² OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark. jeppe.holm.rasmussen@rsyd.dk.
³ Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark.
⁴ Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark.
⁵ Department of Cardiology, Regional Hospital Central Jutland, Silkeborg, Denmark.
⁶ Department of Cardiology, Svendborg Hospital, Svendborg, Denmark.
⁷ Department of Medicine, Nykoebing Falster Hospital, Nykoebing Falster, Denmark.

Abstract

Background: Due to its location very close to the bundle of His, mitral annulus calcification (MAC) might be associated with the development of atrioventricular (AV) conduction disturbances. This study assessed the association between MAC and AV conduction disturbances identified by cardiac implantable electronic device (CIED) use and electrocardiographic parameters. The association between MAC and traditional cardiovascular risk factors was also assessed.

Methods: This cross-sectional study analyzed 14,771 participants, predominantly men aged 60-75 years, from the population-based Danish Cardiovascular Screening trial. Traditional cardiovascular risk factors were obtained. Using cardiac non-contrast computed tomography imaging, MAC scores were measured using the Agatston method and divided into absent versus present and score categories. CIED implantation data were obtained from the Danish Pacemaker and Implantable Cardioverter Defibrillator Register. A 12-lead electrocardiogram was available for 2,107 participants. Associations between MAC scores and AV conduction disturbances were assessed using multivariate regression analyses.

Results: MAC was present in 22.4% of the study subjects. Participants with pacemakers for an AV conduction disturbance had significantly higher MAC scores (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.01-1.23) than participants without a CIED, whereas participants with a CIED for other reasons did not. Prolonged QRS-interval was significantly associated with the presence of MAC (OR, 1.45; 95% CI, 1.04-2.04), whereas prolonged PQ-interval was not. Female sex and most traditional cardiovascular risk factors were significantly associated with high MAC scores.

Conclusions: MAC was associated with AV conduction disturbances, which could improve our understanding of the development of AV conduction disturbances.

Keywords: Cardiac non-contrast computed tomography; Cardiac pacing, artificial; Electrocardiography; Heart block; Mitral annulus calcification.

Abstract

Grants and funding