Serum Fetuin-A and Mitral Annular Calcification As a New Predictors For Significant Coronary Artery Disease

Mitral annular calcification has been shown to be associated with atherosclerosis,
and is a predictor of cardiovascular events. Fetuin-A has recently been described as a
serum-based inhibitor of calcification. The present study was designed to evaluate the
predictive value of serum fetuin-A and mitral annular calcification in patients with
suspected/ diagnosed coronary artery disease. We prospectively studied fifty four
patients with suspected/diagnosed coronary artery disease without renal impairment
or rheumatic valvular disease. The patients divided into 3 groups according to fetuin-
A values. Group 1 low fetuin-A (32 patients). Group 2 normal fetuin-A (12 patients),
group 3 fetuin-A high fetuin-A (10 patients). Full clinical examination, transthoracic
echocardiography, coronary angiography, biochemical investigations offered to all
patients and fetuin-A level measured using EDI human fetuin-A ELISA kit. The results
of the current study showed a higher incidence of mitral annular calcification among
group 1 (59.4%) in comparison to other groups, on other hand the same group had
lower left ventricular ejection fraction percent and higher incidence of resting
regional wall motion abnormalities. Angiography showed a higher prevalence of
severe coronary artery disease in patients with mitral annular calcification than those
without. Group 1 had, also higher prevalence of left main stenosis (43.1%vs 0%)
P<0.05, and triple vessels disease (43.6%vs 13%) P<0.05. While the predictive
ability of Mitral annular calcification in detection of significant coronary artery
disease was highly significant P= 0.0001. There was significant negative correlation
between fetuin-A and hsCRP p<0.01and LDL-c p<0.05. One of the main findings is
the inverse association of serum fetuin-A concentration with Mitral annular
calcification as well as strong predictive value of both to presence of significant
coronary artery disease after multilogestic regression analysis. Conclusion: in
symptomatic patients with suspected coronary artery disease, the presence of low
fetuin-A level and mitral annular calcification, may be considered as independent
predictors for the presence of significant obstructive coronary artery disease.