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Staging Extramitral Cardiac Damage in Mitral Annular Calcification With Mitral Valve Dysfunction
Abdullah Al-Abcha1, Muhannad Abbasi1, Edward El-Am1
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Insights
A new cardiac staging system for mitral annular calcification (MAC) with mitral valve dysfunction shows advanced stages correlate with higher mortality and heart failure hospitalization rates.
Area of Science:
- Cardiology
- Echocardiography
- Valvular Heart Disease
Background:
- Mitral annular calcification (MAC) is a progressive condition linked to comorbidities and mortality.
- A staging system for MAC, including extramitral damage, could aid intervention selection.
Purpose of the Study:
- Develop a transthoracic echocardiogram (TTE)-based cardiac staging system for MAC patients with significant mitral valve dysfunction.
- Assess the prognostic value of this TTE-based staging system.
Main Methods:
- Retrospective analysis of adult patients with MAC and mitral stenosis and/or moderate-to-severe regurgitation undergoing TTE.
- Categorization into 5 stages based on extramitral cardiac damage visualized by TTE.
- Assessment of all-cause mortality and heart failure hospitalization rates.
Main Results:
- 953 patients were analyzed; 2.9% in stages 0-1, 52.4% in stage 2, 12.1% in stage 3, and 32.6% in stage 4.
- Mortality was significantly higher in stages 2-4 versus 0-1 and increased with stage, persisting after adjustments.
- Heart failure hospitalization rates were higher in stages 3 and 4 compared to stages 0-1.
Conclusions:
- The proposed TTE-based staging system for MAC with mitral valve dysfunction effectively stratifies mortality risk.
- More advanced stages of extramitral cardiac damage in MAC are associated with increased mortality and heart failure hospitalizations.
Background:
Mitral annular calcification (MAC) is a progressive degenerative process associated with comorbidities and increased mortality. A staging system that considers extramitral cardiac damage in MAC may help improve patient selection for mitral valve interventions.
Objectives:
This study sought to develop a transthoracic echocardiogram (TTE)-based cardiac staging system in patients with MAC and significant mitral valve dysfunction and assess its prognostic utility.
Methods:
We retrospectively evaluated all adults who underwent TTE over 1 year at Mayo Clinic with MAC and significant mitral valve dysfunction defined as mitral stenosis and/or at least moderate mitral regurgitation. Patients were categorized into 5 stages according to extramitral cardiac damage by TTE. All-cause mortality and heart failure hospitalization were assessed.
Results:
For the 953 included patients, the mean age was 76.2 ± 10.7 years, and 54.0% were women. Twenty-eight (2.9%) patients were classified in stages 0 to 1, 499 (52.4%) in stage 2, 115 (12.1%) in stage 3, and 311 (32.6%) in stage 4. At the 3.8-year follow-up, mortality was significantly higher in patients in stages 2 to 4 compared to stages 0 to 1 and increased with each stage. Survival differences were maintained after adjustment for age, diabetes mellitus, and glomerular filtration rate. The rate of heart failure hospitalization was significantly higher in stages 3 and 4 compared to stages 0 to 1. Similar results were observed in subgroup analysis in patients with moderate or severe MAC, predominant mitral stenosis, or predominant mitral regurgitation.
Conclusions:
Using the proposed extramitral cardiac damage staging system in patients with MAC and significant mitral valve dysfunction, more advanced stages are associated with higher mortality.
