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Mitral annular calcification in severe aortic stenosis: prognostic value of calcification severity and mitral valve

Pierre Vanhaecke1, Yohann Bohbot1,2, Emilion Hucleux1

  • 1Department of Cardiology, Amiens University Hospital, Avenue René Laënnec, 80054 Cedex 1, Amiens, France.

European Heart Journal. Cardiovascular Imaging
|July 24, 2025
PubMed

Insights

Mitral annular calcification (MAC) is common in patients with severe aortic stenosis (AS), impacting survival. Severe MAC or co-occurring mitral valve dysfunction (MVD) significantly reduces long-term survival in these patients.

Area of Science:

  • Cardiology
  • Valvular Heart Disease
  • Echocardiography

Background:

  • Mitral annular calcification (MAC) is frequently observed in patients with severe aortic stenosis (AS).
  • The prognostic implications of MAC severity and concurrent mitral valve dysfunction (MVD) in severe AS are not fully understood.

Purpose of the Study:

  • To investigate the impact of MAC severity and MVD on patient outcomes in severe AS.

Main Methods:

  • Retrospective analysis of 613 patients with severe AS.
  • Categorization based on echocardiographic MAC severity and presence of MVD (mean transmitral gradient ≥5 mmHg).

Main Results:

  • Over 50% of patients had MAC; 21% had MVD. MAC was associated with reduced six-year survival (47% vs. 64%).
  • Severe MAC and MVD independently predicted mortality (HRs 2.63 and 1.86, respectively).
  • Patients with severe MAC or concomitant MVD had significantly lower survival rates.

Conclusions:

  • MAC is highly prevalent in severe AS and is linked to decreased survival.
  • Evaluating MAC severity and MVD is crucial for risk stratification and clinical decision-making in AS patients.
Abstract

Keywords:
aortic stenosismean gradientmitral annular calcificationoutcomesurvival

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