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Mitral annular calcium causing mitral stenosis

Gregg S Pressman1, Ashish Agarwal, Leonard E Braitman

  • 1Division of Cardiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA. PressmanG@einstein.edu

The American Journal of Cardiology
|January 28, 2010
PubMed

Insights

Mitral annular calcium (MAC) can worsen mitral valve function over time. Fifty percent of patients with severe MAC experienced increased mitral valve gradients, particularly those with higher baseline gradients and overall cardiac calcification.

Area of Science:

  • Cardiology
  • Echocardiography
  • Valvular Heart Disease

Background:

  • Mitral annular calcium (MAC) is frequently observed in echocardiography but rarely causes severe mitral stenosis.
  • The natural history of MAC and its impact on mitral valve function remain incompletely understood.
  • MAC is associated with systemic conditions like atherosclerosis and chronic kidney disease.

Purpose of the Study:

  • To investigate the longitudinal progression of mitral valve function in patients with severe mitral annular calcium.
  • To identify factors associated with the progression of mitral valve gradients in this cohort.

Main Methods:

  • A cohort of 37 outpatients with severe MAC (>5 mm) was studied.
  • Thirty-two patients underwent serial echocardiography over a mean follow-up of 2.6 years.
  • Mitral valve gradients and overall cardiac calcification were assessed.

Main Results:

  • Fifty percent (16 of 32) of followed patients showed progression of the mitral valve gradient.
  • Progression rates varied, with some experiencing rapid increases (up to 9 mm Hg/year).
  • Higher baseline gradients and greater overall cardiac calcification predicted faster progression.

Conclusions:

  • While severe mitral stenosis is uncommon in MAC patients, significant risk exists for those with baseline gradients and extensive calcification.
  • Younger age at initial echocardiogram may correlate with a faster rate of calcification progression.
  • Early identification of risk factors is crucial for managing MAC progression and potential valvular dysfunction.

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