Staging Extramitral Cardiac Damage in Mitral Annular Calcification With Mitral Valve Dysfunction.

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.