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  • Mitral Valve Annular Calcification is Associated with Poor Short-term Outcomes after Spontaneous Intracerebral Hemorrhage

    Final Number:

    Lauren N. Dowell BS, MS; Dominique J. Monlezun MPH; Arun Kumar Sherma MD; Natalia P Rincon, MPH; Alex George, BS; Joshua Burak, MD; Ramy El Khoury, MD; Sheryl Martin-Schild, MD, PhD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Spontaneous intracerebral hemorrhage (ICH) constitutes 10-15% of strokes. Treatment of chronic risk factors may play a role in improved outcome and possibly prevent recurrent events. Whether markers of chronic risk factors have prognostic value after ICH is unknown. We sought to determine if mitral annular calcification (MAC), an ultrasound finding associated with chronic hypertension, is a potential marker of poor outcome after ICH.

    Methods: ICH patients admitted to our stroke center (07/2008-03/2014) were analyzed retrospectively using a prospectively collected stroke registry. Univariate and multivariate logistic regression modeling was performed based on the presence of MAC with adjustment for covariates.

    Results: Among 265 patients screened, 160 fit our inclusion criteria (spontaneous ICH, TTE on admission, >18yrs old), with 25% having MAC. Patients were categorized by ICH score: mild (65% patients; score=0-1), moderate (30% patients; score=2-3), and severe (5% patients; score=4-6). Compared to patients without MAC, patients with MAC didn’t have significantly worse stroke severity scores at NIHSS baseline (15 vs. 11, p=0.286). MAC was not associated with increased prevalence of stroke risk factors relative to patients without MAC, including history of hypertension (80.8% vs. 89.1%, p=0.307), diabetes (16.0% vs. 26.8%, p=0.290), or prior strokes (34.6% vs. 23.6%, p=0.300). MAC patients had significantly higher rates of left atrial enlargement (LAE) (57.5% vs. 38.1%, p=0.033). Compared to those without MAC, MAC with LAE patients had significantly increased odds of in-patient mortality (OR=7.50, 95% CI 1.4049-40.0386, p=0.018) and very poor functional outcome at discharge (mRS >4; OR=3.32, 95% CI 1.2502-8.8285, p=0.016). Significance remained even after controlling for age and ICH score, though not for NIHSS baseline severity.

    Conclusions: Our study demonstrates an association between MAC and worse short-term outcome in ICH patients even in the absence of known stroke predictors. MAC may serve as a marker for patients with worse natural histories following ICH.

    Patient Care: Intracerebral hemorrhage continues to be a devastating and challenging disease process. This research highlights the importance of an additional marker, mitral annular calcification, which is not traditionally emphasized in the literature. Treatment and control of mitral annular calcification may play a pivotal role in outcome of ICH patients and may possibly prevent recurrent events.

    Learning Objectives: 1. Describe the importance of additional prognostic markers in patients with spontaneous ICH. 2. Discuss how management of chronic risk factors may play a role in improved outcome and possibly prevent recurrent cerebral events. 3. Identify how outcome in patients with spontaneous intracerebral hemorrhage is affected by non-traditional comorbidities.


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