Is mitral annular calcification an independent predictor of silent cerebral injury? Evaluation using neuron-specific enolase
K Korkmaz, E Sahin, E Us, D E Tutar, C T KayaAbstract
Background
Mitral annular calcification (MAC) has been associated with major cardiovascular conditions, including stroke, heart failure, coronary artery disease, atrial fibrillation, and increased mortality. Whether MAC constitutes an independent risk factor for stroke remains controversial. Previous studies suggest that MAC may contribute to carotid atheroma formation, which in turn increases stroke risk, implying a secondary rather than direct association. Given the coexistence of multiple cardiovascular risk factors in patients with MAC, the increased stroke risk may be coincidental. Neuron-specific enolase (NSE), a biomarker released following neuronal injury caused by ischemia, hypoxia, or trauma, has been widely used to detect both overt and clinically silent cerebral injury. In this study, we aimed to determine whether MAC is independently associated with silent cerebral injury, as assessed by serum NSE levels.
Methods
A total of 150 patients without overt cerebrovascular risk factors were enrolled, including 75 patients with MAC and 75 age-matched controls without MAC. Silent cerebral injury was defined as an NSE level >12 ng/mL. Demographic characteristics, cardiovascular risk factors, and biochemical parameters were analyzed. Logistic regression analysis was performed to identify independent predictors of MAC and silent cerebral injury.
Results
Among the 150 participants, 15 patients (10%) had evidence of silent cerebral injury. Patients with MAC were significantly older (p<0.001) and had a higher prevalence of hypertension (p=0.014) and diabetes mellitus (p<0.001). In logistic regression analysis, age was independently associated with the presence of MAC (OR: 1.08; 95% CI: 1.01–1.15; p=0.025). Median NSE levels were significantly higher in the MAC group (p=0.023). However, MAC was not identified as an independent predictor of silent cerebral injury in multivariable logistic regression analysis.
Conclusion
MAC was significantly associated with advanced age, hypertension, and diabetes mellitus. Although NSE levels were higher in patients with MAC, MAC was not an independent predictor of silent cerebral injury. The increased stroke risk observed in patients with MAC may be attributable to overlapping comorbid cardiovascular risk factors rather than MAC itself. Therefore, additional treatments such as anticoagulation or surgical intervention specifically targeting MAC are not supported; management should focus on optimal control of accompanying cardiovascular risk factors.Regression analysis