A Cardiac Computed Tomography-Based Score to Categorize Mitral Annular Calcification Severity and Predict Valve...

Area of Science:

• Cardiovascular Imaging
• Interventional Cardiology
• Medical Device Technology

Background:

• Transcatheter mitral valve replacement (TMVR) is an emerging treatment for severe mitral annular calcification (MAC).
• Cardiac computed tomography (CT) is crucial for evaluating patients undergoing valve-in-MAC (ViMAC).
• A standardized CT-based grading system for MAC severity is currently lacking.

Purpose of the Study:

• To establish a CT-based scoring system for grading MAC severity.
• To assess the system's ability to predict valve embolization during ViMAC procedures.
• To enhance patient selection and procedural planning for TMVR.

Main Methods:

• Multicenter retrospective review of cardiac CT and clinical outcomes in ViMAC patients.
• Development of a CT-based MAC score incorporating calcium thickness, annular involvement, trigone calcification, and leaflet calcification.
• Assigning points for severity (max 10) and grading (mild, moderate, severe).
• Evaluation of the association between MAC score and device migration/embolization.

Main Results:

• A cohort of 72 patients (trans-septal: 37, transapical: 35) was analyzed.
• Higher MAC scores correlated with lower rates of valve embolization/migration (e.g., MAC score ≥7 had 9.7% vs. ≤6 had 60% embolization).
• A MAC score ≤6 was an independent predictor of valve embolization/migration (OR: 5.86, p=0.049).

Conclusions:

• The developed CT-based score offers a systematic method for grading MAC severity.
• This scoring system may aid in predicting valve embolization/migration during trans-septal or transapical ViMAC.
• The tool can potentially improve safety and outcomes in TMVR procedures.