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Mitral annular calcification in obstructive hypertrophic cardiomyopathy: Incidence, risk factors, and prognostic

Zining Wu1, Changrong Nie1, Changsheng Zhu1

  • 1Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

International Journal of Cardiology
|August 13, 2023
PubMed

Insights

Mitral annular calcification (MAC) in hypertrophic obstructive cardiomyopathy (OHCM) patients undergoing myectomy predicts worse outcomes, including higher mortality and recurrent mitral regurgitation. Moderate-to-severe MAC independently increases the risk of major adverse cardiovascular events post-surgery.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Cardiovascular Surgery

Background:

  • Mitral annular calcification (MAC) is a known cardiac surgery risk factor.
  • Limited data exists on the prognostic value of CT-diagnosed MAC in hypertrophic obstructive cardiomyopathy (OHCM) patients post-myectomy.
  • Investigating MAC's impact on valve function and patient outcomes after OHCM surgery is crucial.

Purpose of the Study:

  • To evaluate the prognostic significance of preoperative computed tomography (CT)-diagnosed mitral annular calcification (MAC) in patients undergoing septal myectomy for hypertrophic obstructive cardiomyopathy (OHCM).
  • To assess the impact of MAC on valve function and long-term clinical outcomes after myectomy.

Main Methods:

  • Retrospective analysis of 1035 consecutive OHCM patients who underwent septal myectomy.
  • Preoperative CT scans were used to diagnose and grade MAC.
  • Kaplan-Meier analysis, log-rank tests, and Cox regression were employed to compare survival and evaluate MAC's impact on endpoint events.

Main Results:

  • MAC was present in 10.8% of OHCM patients, associated with female sex, older age, aortic calcification, and mitral valve thickening.
  • Patients with MAC exhibited higher rates of all-cause mortality, major adverse cardiovascular and cerebrovascular events (MACCE), recurrent mitral regurgitation, and NYHA class III-IV symptoms post-myectomy.
  • Moderate-to-severe MAC was an independent predictor of long-term MACCE (HR 2.03) and MAC independently predicted recurrent mitral regurgitation (HR 2.47).

Conclusions:

  • Preoperative CT-diagnosed MAC is prevalent in OHCM patients and linked to aging and atherosclerosis.
  • OHCM patients with MAC demonstrate a poorer prognosis, including increased MACCE and recurrent mitral regurgitation, following septal myectomy compared to those without MAC.
Abstract

Keywords:
Hypertrophic obstructive cardiomyopathyMitral annulus calcificationSeptal myectomy

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