Relationship between the Achilles tendon strain ratio and the presence of mitral annulus calcification

Purpose: We aimed to investigate the significance of Achilles tendon (AT) thickness ( T) and AT strain ratio (SR), determined by AT ultrasonography (US) and strain elastography (SE), in determining patients with mitral annulus calcification (MAC). Materials and Methods: 100 patients (65 females, 35 males, mean age 64.7 +/- 12.1 years) diagnosed with MAC after echocardiography and 50 control subjects (32 females, 18 males, mean age 63.2 +/- 12.8 years) with similar cardiovascular risk factors were included. Laboratory tests and AT US were performed. AT T and AT-SR were calculated. Results: AT-T and AT-SR were found to be significantly higher in patients with MAC. In multivariate logistic regression analysis, AT -T and AT-SR independently determined the risk for MAC. According to this analysis, AT -T (1 mm each) and AT-SR (0.1 each) increased the risk for MAC by 69.9% and 12.7%, respectively. When ROC was analyzed using AT -T and AT-SR to predict patients with MAC, the areas under the curve (AUC) of ROC were 0.684 and 0.819, respectively. In the same analysis accepting the cut-off value of 1.25 for AT-SR, the presence of MAC was detected with a sensitivity of 94.1% and a specificity of 76.2%. Conclusion: AT-SR detected in AT SE examination is a simple, reproducible, inexpensive, and noninvasive parameter that can be used to predict patients with MAC. This may be due to the fact that the increase in MAC and AT-SR may be associated with similar physiopathological mechanisms.