Abstract 9732: Mitral Annular Calcification and Incident Embolic Stroke in Treated Hypertensive Patients: The LIFE Echo-Substudy

Background: Mitral anular calcification (MAC) is not considered as a substantial echocardiographic finding and is often neglected in routine reports. However, MAC has been associated with increased risk of embolic stroke in the general population. Whether MAC also predicts incident embolic stroke in treated hypertensive patients with LV hypertrophy is unclear. Methods: Baseline clinical and echocardiographic parameters were assessed in 945 hypertensive patients with ECG left ventricular hypertrophy (LVH) participating in the LIFE echo-substudy (66 ±7 years, 42% women, 11% diabetes). Fifteen participants were excluded because of aortic stenosis and 1 because of mitral stenosis. Results: At the baseline echocardiogram, MAC was found in 48% of the study population. Patients with MAC were older (67±7 versus 64±7 years), had higher systolic blood pressure (176±22 versus 171±20 mmHg), heart rate (69±12 versus 67±12 bpm ) left atrial diameter (4.1±0.5 versus 3.8±0.5 cm) and LV mass index (58 ±13 versus 54±12 g/m 2.7 ) and included more women (47% versus 36%), and more patients with diabetes (13% versus 9%) and albuminuria (29% versus 22%, all p<0.01). Over a mean follow-up of 4.8 years, 56 participants (6%) had an embolic stroke. Risk of incident embolic stroke was significantly associated with presence of baseline MAC (log Rank=11, p=0.001). In multivariate Cox- regression analysis, baseline MAC was associated with 2 -fold increased risk of embolic stroke (HR=1.99, CI95%:1.08-3.67,p=0.03), independently of age, gender, baseline systolic BP, heart rate, presence of diabetes, baseline LV mass index, left atrial diameter, albuminuria, prevalent and/or incident atrial fibrillation and randomized antihypertensive treatment (atenolol/losartan). Conclusions: In a population of treated hypertensive patients with ECG LVH, MAC was frequently present and was associated with increased risk for incident embolic stroke, independent of other established risk factors.