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Mitral annular calcification in the elderly - Quantitative assessment
M Eberhard1, A L N Schönenberger1, R Hinzpeter1
1Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland.
Purpose:
To determine the reliability of subjective and objective quantification of mitral annular calcification (MAC) in elderly patients with severe aortic stenosis, to define quantitative sex- and age-related reference values of MAC, and to correlate quantitative MAC with mitral valve disease.
Methods:
In this retrospective, IRB-approved study, we included 559 patients (268 females, median age 81 years, inter-quartile range 77-85 years) with severe aortic stenosis undergoing CT. Four independent readers performed subjective MAC categorization as follows: no, mild, moderate, and severe MAC. Two independent readers performed quantitative evaluation of MAC using the Agatston score method (AgatstonMAC). Mitral valve disease was determined by echocardiography.
Results:
Subjective MAC categorization showed high inter-reader agreement for no (k = 0.88) and severe MAC (k = 0.75), whereas agreement for moderate (k = 0.59) and mild (k = 0.45) MAC was moderate. Intra-reader agreement for subjective MAC categorization was substantial (k = 0.69 and 0.62). Inter- and intra-reader agreement for AgatstonMAC were excellent (ICC = 0.998 and 0.999, respectively), with minor inconsistencies in MAC involving the left ventricular outflow tract/aortic valve. There were significantly more women than men with MAC (n = 227, 85% versus n = 209, 72%; p < 0.001), with a significantly higher AgatstonMAC (median 597, range 81-2055 versus median 244; range 0-1565; p < 0.001), particularly in patients ≥85 years of age. AgatstonMAC showed an area-under-the-curve of 0.84 to diagnose mitral stenosis, whereas there was no association of AgatstonMAC with mitral regurgitation (p > 0.05).
Conclusions:
Our study in elderly patients with severe aortic stenosis shows that quantitative MAC scoring is more reliable than subjective MAC assessment. Women show higher AgatstonMAC scores than men, particularly in the elderly population. AgatstonMAC shows high accuracy to diagnose mitral stenosis.
Insights
Quantitative mitral annular calcification (MAC) scoring is more reliable than subjective assessment in elderly patients with severe aortic stenosis. Women exhibit higher MAC scores, and quantitative MAC accurately diagnoses mitral stenosis.
Area of Science:
- Cardiology
- Radiology
- Geriatrics
Background:
- Severe aortic stenosis often coexists with mitral annular calcification (MAC).
- Accurate MAC quantification is crucial for assessing cardiovascular risk in elderly patients.
- Current subjective MAC assessment methods have limitations in reliability.
Purpose of the Study:
- To evaluate the reliability of subjective and objective MAC quantification in elderly patients with severe aortic stenosis.
- To establish sex- and age-related reference values for quantitative MAC.
- To correlate quantitative MAC with mitral valve disease.
Main Methods:
- Retrospective study of 559 elderly patients with severe aortic stenosis undergoing CT.
- Subjective MAC categorization by four readers; quantitative MAC assessment using Agatston score (AgatstonMAC) by two readers.
- Correlation of AgatstonMAC with mitral valve disease diagnosed by echocardiography.
Main Results:
- Quantitative AgatstonMAC demonstrated excellent inter- and intra-reader agreement (ICC=0.998 and 0.999).
- Women had significantly higher AgatstonMAC scores than men, especially in those aged ≥85 years.
- AgatstonMAC showed high accuracy (AUC=0.84) for diagnosing mitral stenosis but not mitral regurgitation.
Conclusions:
- Quantitative MAC scoring via AgatstonMAC is a reliable method in elderly patients with severe aortic stenosis.
- Higher AgatstonMAC scores in women suggest a sex-specific difference in MAC prevalence and severity.
- Quantitative MAC assessment aids in diagnosing mitral stenosis.
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