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Mitral annular calcification in hypertrophic cardiomyopathy

Daniele Massera1, Yuhe Xia2, Boyangzi Li3

  • 1Hypertrophic Cardiomyopathy Program, NYU Langone Health, New York, NY, United States of America; Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, United States of America.

International Journal of Cardiology
|December 1, 2021
PubMed

Insights

Mitral annular calcification (MAC) in hypertrophic cardiomyopathy (HCM) patients is linked to anterior mitral valve displacement and increased risk of left ventricular outflow tract obstruction (LVOTO). Surgical relief of LVOTO in these patients is safe.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Medical Imaging

Background:

  • Mitral valve anatomy changes can cause left ventricular outflow tract obstruction (LVOTO) in hypertrophic cardiomyopathy (HCM).
  • Mitral annular calcification (MAC) is common in HCM patients, but its role in LVOTO is unclear.

Purpose of the Study:

  • To investigate the association between echocardiographic MAC and anterior mitral valve displacement.
  • To determine if MAC is linked to LVOTO in elderly HCM patients.

Main Methods:

  • Evaluated 304 HCM patients aged ≥ 60 years using echocardiography.
  • Assessed MAC presence, MAC offset distance, and mitral valve displacement.
  • Correlated MAC with systolic anterior motion (SAM) and LVOTO, and analyzed surgical outcomes.

Main Results:

  • MAC was present in 46% of patients and associated with increased rates of SAM and LVOTO.
  • Patients with MAC showed greater anterior mitral valve displacement.
  • MAC offset distance independently predicted LVOTO (OR 1.16 per mm).

Conclusions:

  • MAC is a geometrical alteration contributing to LVOTO in HCM.
  • Surgical LVOTO relief in MAC patients is safe when performed by experienced surgeons.
Abstract

Keywords:
AgingEchocardiographyHypertrophic CardiomyopathyValvular Heart Disease

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