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Prognostic significance of severe mitral annular calcification in aortic stenosis: implications for aortic valve

Valeria Pergola1, Dan-Alexandru Cozac1,2, Maria Teresa Savo1

  • 1Cardiology Unit, Cardio-thoracic-vascular, and Public Health Department, Padova University Hospital, Padova 35128, Italy.

International Journal of Cardiology. Heart & Vasculature
|July 2, 2025
PubMed
Abstract

Insights

Severe mitral annulus calcification (MAC) independently predicts worse cardiovascular outcomes in patients undergoing aortic valve replacement (AVR). This finding suggests MAC is a crucial prognostic factor impacting patient care after AVR.

Area of Science:

  • Cardiology
  • Cardiac Imaging
  • Valvular Heart Disease

Background:

  • Mitral annulus calcification (MAC) is increasingly recognized beyond its association with aging.
  • Emerging evidence links MAC to calcific aortic stenosis (AS), but its prognostic significance in AS patients undergoing aortic valve replacement (AVR) requires further investigation.

Purpose of the Study:

  • To evaluate the impact of cardiac CT-derived MAC on cardiovascular outcomes in patients with severe AS undergoing AVR.
  • To determine if MAC severity is an independent predictor of adverse events post-AVR.

Main Methods:

  • Utilized pre-procedural contrast-enhanced cardiac CT (CCT) to quantify MAC severity using the Guerrero CCT-derived MAC score.
  • Assessed major adverse cardiovascular events (MACE), including cardiovascular mortality, arrhythmias, stroke, and heart failure hospitalizations, over 60 months post-AVR.
  • Employed multivariate Cox models to identify independent predictors of MACE and mortality.

Main Results:

  • Included 313 patients with severe AS undergoing AVR; 65.4% had MAC (12.1% severe MAC).
  • Severe MAC, moderate-to-severe mitral regurgitation, and STS score > 2.5% were independent predictors of MACE (p < 0.05).
  • Severe MAC and STS score > 2.5% independently predicted all-cause mortality (p < 0.05).

Conclusions:

  • Severe MAC is an independent predictor of adverse cardiovascular outcomes in patients undergoing AVR.
  • Integrating MAC assessment into clinical evaluation may significantly alter patient management strategies.
  • MAC severity provides valuable prognostic information in the context of AS and AVR.
Keywords:
Cardiac computed tomographyCardiovascular outcomesMitral annulus calcificationPredictors

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