Różnice płciowe w klinicznych czynnikach zaawansowania miażdżycy tętnic wieńcowych u chorych ze zwapnieniami zastawki aortalnej i/lub pierścienia mitralnego

Valerii P. Ivanov, Natalia Y. Osovska, Oksana L. Baranova, Olena V. Iuzvyshyna, Yuliia V. Savitska,
Viktor V. Khomovskyi, Ruslan V. Svistilnik

NATIONAL PIROGOV MEMORIAL MEDICAL UNIVERSITY, VINNYTSIA, UKRAINE

 

ABSTRACT

Introduction: The previous studies of coronary atherosclerosis association with aortic valve calcification (AVC) and/or mitral annulus calcification (MAC) had contradictory results.

The aim: To assess gender differences in clinical factors associated with coronary artery atherosclerosis severity.

Materials and methods: 362 patients (mean age 63.9 (8.8) years, 244 (67.4%) males) who underwent coronary angiography were included in the retrospective study. AVC and/or MAC presence was determined using transthoracic echocardioscopy. Coronary angiography results were assessed using coronary atherosclerosis severity index (CASI).

Results: There were lower CASI in aortic stenosis (AS) subgroups (0 (0; 3.5) and (0; 9.5) in subgroups with severe and moderate AS respectively versus 12.0 (6.0; 20.5) in subgroup without AS, p<0.005). Man with AVC and/or MAC (without AS and diabetes mellitus (DM)) had higher CASI compared to man without heart valve calcification and without DM (15.0 (7.0; 21.5) versus 7.0 (2.0; 12.0), p=0.0002), whereas in the similar woman subgroups CASI did not differ. In the male group without DM (without AS) CASI was associated with age (r=0.319, p<0.0001), glomerular filtration rate (GFR) (r=(-0.164), p=0.049), cholesterol level (r=0.242, p=0.003) and the combined presence of AVC and MAC (r=0.229, p=0.006), whereas in the similar female group there were only CASI association with GFR (r=(-0.252), p=0.050) and with combined presence of AVC and MAC (r=0.219, p=0.080).

Conclusions: CASI depended on AS severity. In subgroups without AS and DM CASI was associated with combined presence of AVC and MAC, GFR, and besides with age and cholesterol level in man.

Key words:

Wiad Lek 2018, 71, 6, -1154

 

INTRODUCTION

The coronary artery atherosclerosis is the common cause of cardiovascular mortality. 7.8 million cases of coronary artery disease (CAD) was recorded in Ukraine in 2016, and CAD mortality level reached 702.76 cases per 100 000, which twice overdraws the West-Europe CAD mortality level [1]. The traditional risk factors include age, male gender, smoking, hypertension, obesity, diabetes mellitus (DM), and hypercholesterolemia. In Cardiovascular Health Study (1997) the aortic valve sclerosis was revealed in 26 % of people aged 65 years and more [2] and was associated with the increased myocardial infarction (MI) risk even after the exclusion of the influence of concomitant cardiovascular risk factors. Patients with chest pain and aortic sclerosis during the primary examination had a higher incidence of MI and cardiovascular death during the 1-year observation, although multivariable analysis shows that the aortic sclerosis was not the independent predictor associated with adverse cardiovascular outcomes [3]. The mitral annulus calcification (MAC) incidence increases with age (about 6% of males after 70 years and 11.9 % of females aged 70-79 years to 22.4 % of females aged 80 years and more) and associated with aortic valve calcification (AVC), aortic stenosis (AS), atrial fibrillation, cardiovascular events and stroke. [4]. Examining patients in the cardiology department we revealed AVC and/or MAC in 4.3 % (patients aged 50-59 years) to 30.1 % (patients aged 80 years and more) [5]. Thus a patient with AVC and/or MAC (sufficiently common condition for elderly cardiological patients) requires more careful evaluation of cardiovascular risk. The evidences of CAD association with AVC and/or MAC were contradictory. Several authors proposed to consider AVC and MAC as markers of CAD and the atherosclerosis of other localizations. [4, 6]. M. Henein at al. (2015) described the lack of relation between AVC and coronary artery calcification and stenosis in patients with severe aortic stenosis (AS), but it was a relationship between the coronary and the aortic root calcification [7]. H. Yamamoto at al. (2003) revealed that AVC and the thoracic aortic calcification were associated with the angiographic extent and severity of CAD whereas MAC did not [8]. In study of H. Utsunomiya (2010) the combined presence of AVC and MAC was associated with the presence, extent, and vulnerable characteristics of coronary plaque as distinction from the lack of association in patients with isolated AVC or without valve calcification [9]. In the research of S. Atar et al. (2003) it was revealed MAC association with an increased prevalence of severe atherosclerosis of coronary artery in patients under 65 years old [10].

THE AIM

To assess gender differences in clinical factors associated with coronary artery atherosclerosis severity in patients with AVC and/or MAC. We hypothesized that AVC and/or MAC presence associates with the extent and severity of coronary artery atherosclerosis.

MATERIALS AND METHODS

362 patients (41 to 92 years old, the mean age is 63.9 (8.8) years old, including 244 (67.4%) males) who underwent coronary angiography in the cardiac surgery department of Kmelnytsky regional hospital during 2010-2017 were included in the retrospective study analysis. Exclusion criteria: age <40 years (for patients without AVC and/or MAC), stroke (less than 6 months), congenital heart disease (for the exception of the bicuspid aortic valve), cardiomyopathy, myocarditis, rheumatic heart disease, systemic diseases of connective tissue, oncological diseases. The demographic and clinical data were obtained from the patients’ records.

316 (87.3%) patients had CAD including 124 (34.2 %) patients with acute MI (including 24 (6.6 %) cases of repeated MI) and 85 (23.5 %) patients with old MI (18 (4.9 %) patients with repeated MI). 27 (7.5 %) patients underwent coronary angiography because of instable angina pectoris and 80 (22.1 %) – because of stable angina pectoris III-IV FC. 344 (95%) patients were hypertensive and 91 (25.1%) has DM.

All patients were divided into two groups depending on presence or absence of valve calcification. The patients of the basic group (n=290) had AVC and/or MAC and the patients of the comparison group (n=72) did not have heart valve calcification (HVC). Both groups were randomized by age and gender. We assessed CAD, hypertension and DM presence, smoking status, body mass index (BMI), cholesterol level and glomerular filtration rate (GFR) calculated by the MDRD formula for kits without creatinine standardization.

AVC and/or MAC presence was determined using the transthoracic echocardioscopy (Siemens Acuson CV70, Germany). AS degree was assessed using ASE recommendation [11]. The presence of the coronary atherosclerosis was determined by the coronary angiography (angiography system Infinix VC-I, Toshiba Мedical Systems, Japan). The coronary angiography results were assessed using the coronary atherosclerosis severity index (CASI) that represented the prevalence and severity of the lesion of the coronary artery. The plaque location and the degree of stenosis were taken into consideration (each coronary segment was assigned a certain number of points depending on the location which was multiplied by 2 in the case of 50–99% of stenosis and by 5 in the case of total occlusion) using the Guide to calculate by the SYNTAX score [12]. We used only assessment of dominance, the coronary segment and the diameter of stenosis according to the SYNTAX score. The SYNTAX score was developed to facilitate the selection of the optimal surgical treatment strategy, whereas the aim of our study was to estimate severity of atherosclerosis, so we did not take into account the presence of thrombus, the lesion length and the vessels diameter, the signs of occlusion standing. The calculated CASI was 10.0 (2.0; 18.0) range 0-37.5.

The statistical analysis was performed using Excel v.7.0 (Microsoft) and STATISTICA v.12.0 (Softserve) programs. The numerical values are reported as mean (SD) or median (lower and upper quartiles) for data with non normal distribution and as a proportion of the sample size. Comparisons between the groups were made using the χ2 test and Mann-Whitney U-test. Relationships were assessed using Spearmen rank order correlation. Differences were considered as reliable with p<0.05.

RESULTS AND DISCUSSION

The patients’ clinical characteristics are presented in table I. There were no significant differences between the groups in hypertension, DM and smoking prevalence, BMI, and cholesterol level. The patients of the basic group with AVC and/or MAC had lower prevalence of CAD but higher IM/CAD ratio compared to the patients of the other (comparison) group. GFR was significantly lower in the basic group with AVC and/or MAC. CASI did not differ in groups.

Gender differences in clinical characteristics are adduced in table II. Females were older then males (significantly older in the basic group). Females in the basic group were more often hypertensive and had higher BMI compared to males. Females in the comparison group had higher DM prevalence compared to females in the basic group. CAD prevalence was higher in the comparison group both in males and in females and it was a tendency to higher MI/CAD ratio in the basic group. Prevalence of different types of valves lesion (isolated AVC or MAC or combined presence AVC and MAC) and AS did not differ significantly in males and females (with the exception of higher prevalence of isolated MAC in females on the board of statistical significance). There were no significant differences of CASI in subgroups.

Our basic group included patients who underwent the coronary angiography before the aortic valve prosthesis (with moderate and severe AS); therefore we analyzed CAD prevalence depend on presence and severity of the AS (table III). CAD prevalence and CASI were significantly lower in the subgroups of patients with moderate and severe AS compared to the subgroup with no aortic valve stenosis. The number of patients with CASI=0 was also the lowest in the subgroup without AS and the highest in the subgroup with severe AS.

For assessing of AVC and/or MAC influence on the coronary atherosclerosis severity we excluded patients with AS (taking into consideration the different grade of association of coronary artery atherosclerosis and HVC depending on the presence and severity of AS) and patients with DM (taking into consideration the differences in DM (significant risk factor of coronary atherosclerosis) prevalence in groups (from 16.7 % to 38.9 %)) and created subgroups: the basic (patients with AVC and/or MAC with no AS and without DM, n=149) and the comparison group (patients without HVC and without DM, n=56). Patients’ characteristics are presented in table IV and table V. Patients of the basic subgroup were older although it was on the board of statistical significance only in the male subgroups. Prevalence of isolated AVC and combined presence of AVC and MAC was not different for males and females; females more often had isolated MAC. CAD prevalence did not differ but MI/CAD ratio was higher in patients with HVC and this tendency was presented both in males and females. Females with AVC and/or MAC had higher BMI compared to males of the basic subgroup and females without HVC. Males with HVC had higher cholesterol level compared to males of the comparison group and with females of the basic subgroup (these differences lay on the board of statistical significance). GFR was significantly lower in females compared to males both in the basic and in the comparison subgroup and males with AVC and/or MAC had lower GFR then males without HVC. CASI was significantly higher in patients with AVC and/or MAC in male patients, whereas in female subgroups CASI did not differ depending on AVC and/or MAC. Males of the basic group had a higher CASI compared to females of the basic group.

Males with AVC and/or MAC were older, had a higher cholesterol level and a lower GRF in comparison with males without HVC, i.e. there were differences in prevalence of the atherosclerosis risk factors. But when the comparison male subgroup was created using the described sample without AS and without DM (n=57, with the mean age of 61.6 (±8.9) years, cholesterol level 5.4 (4.9; 5.7) mmol/l, GFR 71.0 (68.6; 86.4) ml/min/1.73 m2), CASI remained significantly higher compared to the male subgroup (without HVC and without DM) – 13.5 (7.0; 19.5) against 10.0 (0; 17.5), р=0.013.

Association of CASI with age, BMI, smoking, hypertension, DM, GFR, cholesterol level and presence of different types of valve calcification (isolated AVC or MAC or combined presence of AVC and MAC) were assessed using the correlation analysis. CASI was associated with DM in the group of patients without AS (with and without HVC) (significantly in females – r=0.222, p=0.039 and on the board of statistical significance in males – r=0.122, p=0.098). Patients with DM (40 males and 26 females with and without HVC) had no association of CASI with age, BMI, hypertension, smoking, GFR, cholesterol level and presence of different types of valve calcification, both in the male and the female group (there was only CASI and GFR association on the board of statistical significance in females, r=(-0.349), p=0.080). CASI was associated with age (r=0.319, p<0.0001), GFR (r=(-0.164), p=0.049), cholesterol level (r=0.242, p=0.003) and the combined presence of AVC and MAC (r=0.229, p=0.006) in the male group without DM (without AS, with and without HVC, n=144), whereas in the similar female group (n=61) there was only CASI associated with GFR (r=(-0.252), p=0.050) and with the combined presence of AVC and MAC on the board of statistical significance (r=0.219, p=0.080).

Patients with the isolated AVC or combined presence of AVC and MAC had significantly lower CAD prevalence and CASI in subgroups of patients with moderate and severe AS compared to the subgroup with no AS. Such differences in CAD prevalence depend on AS severity can be explained by the heterogeneity of patients with the severe AS with various degree of association with coronary atherosclerosis. It is adjusted to the previous data because it was described both as a symptomatic clinical course of AS caused by calcification with manifestation with angina, congestive heart failure, and syncope and so the increased MI and the cardiovascular death risk in patients with the aortic sclerosis [3,13]. Studies of the genetic features of AS caused by calcification revealed associations with the genetic polymorphisms of apolipoproteins AI, B, and E, genetic polymorphisms of interleukin-10, connective tissue growth factor, transforming growth factor ß receptor and chemokine receptor-5, vitamin D receptors polymorphism, the linkage of the aortic valve sclerosis to chromosome 16q22.1-q22.3 and 19p13.11-p11, and different studies demonstrated various results, not always confirmed by each other [14-19]. Thus, the polygenic nature of AS caused by calcification can be supposed, with different clinical features of various genetic variants.

Higher incidence of MI and cardiovascular death in patients with chest pain and the aortic valve sclerosis during the followed observation, described by C.Otto et al., (1999), was explained by non-diagnostic cases of CAD at the beginning of study [6]. In our study higher MI/CAD ratio was revealed in the patients’ groups with AVC and/or MAC compared to the groups without HVC, both in males and in females. Thus, patients with CAD had higher MI risk having AVC and/or MAC. Males with AVC and/or MAC, without AS, and without DM had more severe coronary atherosclerosis (significantly higher CASI) in comparison with the group without HVC and without DM. CASI did not differ in females depending on AVC and/or MAC presence. Males of the basic subgroup had higher CASI compared with females of the basic subgroup. The lack of CASI differences depending on AVC and/or MAC presence in females may be related to lower level of GFR by comparison with males (and this cardiovascular risk factor influence can blend AVC and/or MAC influence). We did not succeed to create the sufficient female subgroup with normal GFR based on the available material. Besides, female subgroups had significant differences in age, BMI and cholesterol level. Both males and females with HVC (without AS and without DM) had CASI association with combined presence of AVC and MAC. Revealed association of coronary atherosclerosis severity and combined presence of AVC and MAC were adjusted in the previous studies. [9,10]

CONCLUSIONS

1. Patients with the isolated AVC or combined presence of AVC and MAC had significantly lower CAD prevalence and CASI in subgroups of patients with moderate and severe AS compared to the subgroup without sign of AS.

2. In subgroups without AS and without DM males with AVC and/or MAC had significantly higher CASI compared to males without HVC and without DM, whereas in similar female subgroups CASI did not differ depending on AVC and/or MAC presence.

3. In comparable (in mean age, cholesterol level, GFR) man subgroup formed from sample without AS and without DM CASI remained significantly higher than in comparison man subgroup (without HVC and without DM).

4. In the male subgroup without DM (without AS, with and without HVC) CASI was associated with age, GFR, cholesterol level and combined presence of AVC and MAC, and in similar female subgroup there was only CASI association with GFR and with the combined presence of AVC and MAC on the board of statistical significance.

REFERENCES

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2. Stewart BF, Siscovick D, Lind BK et al. Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study. J Am Coll Cardiol. 1997; 29:630-4.

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4. Adler Y, Fink N, Spector D et al. Mitral annulus calcification — a window to diffuse atherosclerosis of the vascular system. Atherosclerosis. 2001;155: 1–8.

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Authors’ contributions:

According to the order of the Authorship.

Conflict of interest:

The Authors declare no conflict of interest.

CORRESPONDING AUTHOR

Oksana L. Baranova

Department of Therapy, Post-Graduate Faculty

Vinnytsia National Pirogov Memorial Medical University,

Vodoprovidna street, 8/1, 29000, Khmelnytskyi, Ukraine

tel: +380971325952

e-mail: ggoolld@ukr.net

Received: 26.03.2018

Accepted: 05.07.2018

Table I. Clinical and instrumental characteristics of patients’ groups with and without aortic valve and/or mitral annulus calcification

Clinical and instrumental characteristics

Patients with AVC and/or MAC (n=283)

Patients without HVC (n=72)

Р

Mean age, years, М (± SD)

63.9 (±8.5)

61.9 (±8,1)

0.063

Males, n (%)

186 (65.7)

70 (97.2)

0.133

Hypertension, n (%)

267 (94.3)

70 (97.2)

0.321

CAD, n (%)

238 (84.1)

71 (98.6)

0.001

MI, n (%)

163 (57.6)

39 (54.2)

0.599

MI/CAD ratio, %

68.5

54.9

0.035

DM, n (%)

72 (25.4)

16 (22.2)

0.572

Smokers, n (%)

38 (13.1)

8 (11.1)

0.601

Isolated AVC, n (%)

168 (59.4)

 

Isolated MAC, n (%)

14 (4.9)

 

Combined presence of AVC and MAC, n (%)

101 (35.7)

 

Aortic stenosis, n (%)

84 (29.7)

 

BMI, kg/m2

28.1 (25.6; 31.9)

27.7 (24.9; 30.9)

0.247

Cholesterol level, mmol/l

5.4 (4.9; 5.9)

5.3 (5.0; 5.7)

0.940

GFR, ml/min/1,73 m2

67.7 (51.9; 78.8)

71.7 (61.5; 87.4)

0.007

CASI, score

10.0 (0; 18.5)

9.25 (3.0; 17.25)

0.999

Notes: AVC – aortic valve calcification, MAC – mitral annulus calcification, HVC – heart valve calcification, CAD – coronary artery disease, MI – myocardial infarction, DM – diabetes mellitus, BMI – body mass index, GFR – glomerular filtration rate, CASI – coronary atherosclerosis severity index

Table II. Clinical and instrumental characteristic of the patients’ groups with /without the aortic valve and/or the mitral annulus calcification depending on gender

Clinical and instrumental characteristics

Males with AVC and/or MAC (n=186)

Males without HVC (n=54)

Females with AVC and/or MAC (n=97)

Females without HVC (n=18)

р

1

2

3

4

Mean age, years,

М (± SD)

62.8 (±8.6)

61.0 (±7.3)

65.9 (±8.0)

64.5 (±9.8)

р1-2=0.215

р3-4=0.426

р1-3=0.005

р2-4=0.307

Hypertension, n (%)

171 (91.9)

53 (98.2)

96 (99.0)

17 (94.4)

р1-2=0.107

р3-4=0.177

р1-3=0.015

р2-4=0.407

CAD, n (%)

156 (83.9)

53 (98.2)

82 (84.5)

18 (100.0)

р1-2=0.006

р3-4=0.074

р1-3=0.885

р2-4=0.561

MI, n (%)

105 (56.5)

29 (53.7)

58 (59.8)

10 (55.6)

р1-2=0.720

р3-4=0.737

р1-3=0.589

р2-4=0.891

MI / CAD ratio, %

67.3

54.7

70.7

55.6

р1-2=0.099

р3-4=0.211

р1-3=0.589

р2-4=0.891

DM, n (%)

43 (23.1)

9 (16.7)

29 (29.9)

7 (38.9)

р1-2=0.311

р3-4=0.449

р1-3=0.214

р2-4=0.049

Smokers, n (%)

37 (19.9)

8 (14.8)

1 (1.0)

0 (0)

р1-2=0,400

р3-4=0,665

р1-3<0.0001

р2-4=0.083

Isolated AVC, n (%)

114 (61.3)

 

54 (55.7)

 

р1-3=0.361

Isolated MAC, n (%)

6 (3.2)

 

8 (8.2)

 

р1-3=0.065

Combined presence of AVC and MAC, n (%)

66 (35.5)

 

35 (36.1)

 

р1-3=0.921

AS, n (%)

56 (30.1)

 

28 (28.9)

 

р1-3=0.828

BMI, kg/m2

27.7 (24.8; 30.7)

28.1 (25.0; 31.6)

30.5 (26.3; 33.5)

25.8 (24.8; 27.9)

р1-2=0.423

р3-4=0.002

р1-3=0.0002

р2-4=0.162

Cholesterol level, mmol/l

5.5 (4.9; 5.9)

5.3 (5.0; 5.7)

5.2 (4.9; 5.8)

5.4 (5.0; 5.8)

р1-2=0.496

р3-4=0.423

р1-3=0.325

р2-4=0.466

GFR, ml/min/1,73 m2

70.6(60.5; 82.4)

76.1 (68.4; 91.7)

54.5 (44.5; 66.6)

55.7 (46.9; 67.8)

р1-2=0.019

р3-4=0.577

р1-3<0.0001

р2-4<0.0001

CASI, score

10.0 (2.5; 19.5)

9.0 (3.0; 15.5)

7. 5 (0; 16.5)

12.75 (3.0; 18.0)

р1-2=0.335

р3-4=0.168

р1-3=0.087

р2-4=0.333

Notes: AVC – aortic valve calcification, MAC – mitral annulus calcification, HVC – heart valve calcification, CAD – coronary artery disease,
MI – myocardial infarction, DM – diabetes mellitus, BMI – body mass index, GFR – glomerular filtration rate,
CASI – coronary atherosclerosis severity index

Table III. Prevalence of the coronary artery disease and the coronary atherosclerosis severity index (CASI) depend on presence and severity of the aortic stenosis.

Patients groups

CAD, n (%)

Patients with CASI=0, n (%)

CASI, score

1

AVC with or without MAC with no AS (n=199)

198 (99.5)

32 (16.1)

12.0 (6.0; 20.5)

2

AVC with or without MAC with mild AS (n=27)

25 (92.6)

5 (18.5)

10.0 (7.0; 15.0)

3

AVC with or without MAC with moderate AS (n=16)

7 (43.7)

7 (43.7)

2.5 (0; 9.5)

4

AVC with or without MAC with severe AS (n=41)

8 (19.5)

27 (65.8)

0 (0; 3.5)

Р

 

р١-٢=٠.٠٠٣

р١-٣<٠.٠٠٠١

р١-٤<٠.٠٠٠١

р٢-٣=٠.٠٠٠٤

р٢-٤<٠.٠٠٠١

р٣-٤= ٠.٠٦٢

р١-٢=٠.٧٤٨

р١-٣=٠.٠٠٦

р١-٤<٠.٠٠٠١

р٢-٣=٠.٠٧٥

р٢-٤<٠.٠٠٠١

р٣-٤= ٠.١٢٦

р١-٢=٠.١٤٦

р١-٣=٠.٠٠٥

р١-٤<٠.٠٠٠١

р٢-٣=٠.٠٦٨

р٢-٤<٠.٠٠٠١

р٣-٤= ٠.٠٩٧

AVC – aortic valve calcification, MAC – mitral annulus calcification, CASI – coronary atherosclerosis severity index, AS – aortic stenosis,
CAD – coronary artery disease

Table IV. Clinical and instrumental characteristic of patients groups with/without aortic valve and/or mitral annulus calcification (the subgroup without aortic valve stenosis and without diabetes mellitus)

Clinical and instrumental characteristics

Patients with AVC and/or MAC (without AS and without DM) (n=149)

Patients without HVC (without DM)

(n=56)

Р

Mean age, years,

М (± SD)

64.2 (±8.7)

61.3 (±7.9)

0.042

Males, n (%)

99 (66.4)

45 (80.4)

0.052

Hypertension, n (%)

142 (95.3)

54 (96.4)

0.725

CAD, n (%)

148 (99.3)

55 (98.2)

0.469

MI, n (%)

102 (68.5)

28 (50.0)

0.014

MI/CAD ratio, %

68.9

50.9

0.017

Smokers, n (%)

10 (6.7)

8 (14.3)

0.088

Isolated AVC, n (%)

89 (59.7)

 

Isolated MAC, n (%)

11 (7,4)

 

Combined presence of AVC and MAC, n (%)

49 (32.9)

 

BMI, kg/m2

27.6 (25.3; 31.5)

27.6 (24.5; 30.5)

0.337

Cholesterol level, mmol/l

5.5 (5.0; 5.9)

5.3 (5.0; 5.7)

0.284

GFR, ml/min/1,73 m2

67.3 (51.9; 75.9)

70.1 (62.1; 87.4)

0.015

CASI, score

12.0 (6.0; 19.5)

7.75 (2.0; 13.0)

0.002

Notes: AVC – aortic valve calcification, MAC – mitral annulus calcification, HVC – heart valve calcification, CAD – coronary artery disease,
MI – myocardial infarction, DM – diabetes mellitus, BMI – body mass index, GFR – glomerular filtration rate,
CASI – coronary atherosclerosis severity index

Table V. Clinical and instrumental characteristics of patients groups with/without aortic valve and/or mitral annulus calcification (the subgroup without aortic stenosis and without diabetes mellitus) depending on gender

Clinical and instrumental characteristics

Males with AVC and/or MAC

(without AS and without DM)

(n=99)

Males without HVC

(without DM) (n=45)

Females with AVC and/or MAC (without AS and without DM) (n=50)

Females without HVC

(without DM) (n=11)

р

1

2

3

4

Mean age, years,

М (± SD)

63.2 (±9.1)

61.1 (±7.3)

66.3 (±7.5)

61.9 (±8.8)

р1-2=0.302

р3-4=0.103

р1-3=0.072

р2-4=0.812

Hypertension,

n (%)

92 (92.9)

44 (97.8)

51 (100)

10 (90.9)

р1-2=0.239

р3-4=0.032

р1-3=0.054

р2-4=0.271

CAD,

n (%)

98 (99.0)

44 (97.8)

50 (100)

11 (100)

р1-2=0.565

р3-4=1.0

р1-3=0.476

р2-4=0.618

MI,

n (%)

68 (68.7)

24 (53.3)

34 (68.0)

4 (36.4)

р1-2=0.075

р3-4=0.050

р1-3=0.932

р2-4=0.313

MI/CAD ratio, %

69.4

54.5

68.0

36.4

р1-2=0.087

р3-4=0,050

р1-3=0,863

р2-4=0,281

Smokers,

n (%)

10 (10.1)

8 (17.8)

0 (0)

0 (0)

р1-2=0.197

р3-4=1.0

р1-3=0.020

р2-4=0.131

Isolated AVC,

n (%)

59 (59.6)

30 (60)

р1-3=0.962

Isolated MAC,

n (%)

4 (4.0)

7 (14)

р1-3=0.029

Combined presence of AVC and MAC, n (%)

36 (36.4)

13 (26)

р1-3=0.783

BMI, kg/m2

27.1 (24.4; 29.7)

28.1 (24.2; 31.0)

30.4 (26.8; 33.5)

25.6 (24.8; 27.6)

р1-2=0.294

р3-4=0.001

р1-3=0.002

р2-4=0.119

Cholesterol level, mmol/l

5.6 (5.0; 6.0)

5.3 (5.0; 5.7)

5.3 (5.0; 5.8)

5.6 (5.3; 5.8)

р1-2=0.059

р3-4=0.305

р1-3=0.081

р2-4=0.197

GFR, ml/min/1,73 m2

69.9 (59.7; 81.9)

73.4 (67.3; 90.1)

54.4 (45.4; 66.6)

54.0 (46.7; 67.8)

р1-2=0.075

р3-4=0.793

р1-3<0.0001

р2-4=0.0006

CASI, score

15.0 (7.0; 21.5)

7.0 (2.0; 12.0)

10.5 (0; 17.5)

10.5 (3.0; 17.5)

р1-2=0.0002

р3-4=0.796

р1-3=0.010

р2-4=0.364

Notes: AVC – aortic valve calcification, MAC – mitral annulus calcification, HVC – heart valve calcification, CAD – coronary artery disease,
MI – myocardial infarction, DM – diabetes mellitus, BMI – body mass index, GFR – glomerular filtration rate, CASI – coronary atherosclerosis severity index