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Concomitant mitral annular calcification and severe aortic stenosis: prevalence, characteristics and outcome

Yigal Abramowitz1, Yoshio Kazuno1, Tarun Chakravarty1

  • 1The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

European Heart Journal
|January 1, 2017
PubMed

Insights

Mitral annular calcification (MAC) affects nearly half of patients undergoing transcatheter aortic valve replacement (TAVR). Severe MAC independently predicts higher mortality and pacemaker implantation post-TAVR, necessitating its inclusion in risk models.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Interventional Cardiology

Background:

  • Mitral annular calcification (MAC) shares etiological and pathophysiological links with aortic stenosis (AS).
  • MAC is commonly observed in computed tomography (CT) scans before transcatheter aortic valve replacement (TAVR).
  • The prognostic significance of MAC in TAVR patients remains under-investigated.

Purpose of the Study:

  • To determine the prevalence of MAC in patients with severe AS undergoing TAVR.
  • To evaluate the clinical impact of MAC on outcomes during and after TAVR.

Main Methods:

  • A cohort of 761 patients undergoing TAVR was analyzed.
  • Patients were stratified based on the presence and severity of MAC identified in pre-TAVR CT scans.
  • Multivariable survival analysis was employed to assess predictors of mortality and complications.

Main Results:

  • MAC was present in 49.3% of patients; severe MAC was identified in 9.5%.
  • Thirty-day mortality and major complications did not differ significantly between patients with and without MAC.
  • Severe MAC independently predicted increased all-cause and cardiovascular mortality (HR 1.95 and 2.35, respectively).
  • Severe MAC also predicted the need for permanent pacemaker implantation (PPI) post-TAVR (OR 2.83).

Conclusions:

  • MAC is highly prevalent in patients with severe AS evaluated for TAVR.
  • Severe MAC is a significant independent predictor of adverse outcomes, including mortality and conduction abnormalities.
  • Incorporating MAC assessment into TAVR risk stratification models is recommended.
Abstract

Keywords:
Mitral annulus calcificationTAVITAVRTranscatheter aortic valve implantation

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