Ischemic Stroke and Mitral Annular Caseous Calcification: A Neglected Embolic Risk in Cardio-Neurological Interface?

OBJECTIVES

Case reports indicate that caseous mitral annulus calcification (MAC), also termed mitral annulus caseous granuloma, may contribute to stroke and systemic embolism. This retrospective case-control study aimed to assess the prevalence of caseous MAC detected through cardiac computed tomography (CT) in an acute stroke cohort and to identify factors associated with its occurrence.

METHODS

A total of 149 patients with acute ischemic stroke who underwent emergency cardiac CT, 300 acute ischemic stroke patients who did not undergo cardiac CT, and 268 individuals who underwent cardiac CT but had no history of stroke were included. The first group was consecutively selected (January 2022 to November 2024), while the other 2 groups were identified through propensity matching based on age and sex. Various regression models were applied to determine the degree of association.

RESULTS

Caseous MAC was detected in 5.4% of stroke patients who underwent cardiac CT, a prevalence significantly higher than in the control group (1.1%, P =0.02). Regression models demonstrated that caseous MAC significantly ( P =0.011) and independently increased stroke risk by a factor of 7.57 to 10.81 (95% CI: 1.54-36.20).

CONCLUSIONS

These findings suggest that caseous mitral annulus calcific granuloma may be a potential cause of embolic stroke. Further prospective, multicenter studies are needed to validate these results.