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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
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Mitral annular calcification score by computed tomography in patients undergoing mitral valve surgery
Yuichiro Okushi1, Shinya Unai2, Gösta B Pettersson2
1Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
European Heart Journal. Imaging Methods and Practice
|July 28, 2025
Summary
Mitral annular calcification (MAC) severity, classified by a new multi-parametric score, predicts mortality in patients undergoing mitral valve surgery. Severe MAC indicates a poorer prognosis, highlighting the score's clinical utility.
Area of Science:
- Cardiology
- Medical Imaging
- Surgical Outcomes
Background:
- Mitral annular calcification (MAC) complicates mitral valve (MV) surgery and is linked to mortality.
- A standardized method for classifying MAC severity is lacking.
- Computed tomography (CT) enables a multi-parametric MAC score.
Purpose of the Study:
- To evaluate the prognostic impact of a novel multi-parametric MAC score for classifying MAC severity.
- To assess the association between severe MAC and mortality in patients undergoing MV surgery.
Main Methods:
- A cohort of 331 patients with MAC undergoing MV surgery (2011-2019) was analyzed.
- A MAC score (range 2-12) was calculated using CT-derived parameters: Agatston calcium score, MAC angle, left ventricular outflow tract extension, trigone involvement, and myocardial infiltration.
- Patients were categorized into severe (top tertile, scores 9-12) and non-severe MAC groups.
- Propensity score matching was used to adjust for clinical confounders.
Main Results:
- After propensity score matching (60 patients per group), no significant difference in in-hospital mortality was observed.
- Patients with severe MAC demonstrated significantly higher all-cause mortality (25.0%) compared to non-severe MAC (8.3%, P=0.026).
- The median follow-up was 220 days, with 14.2% overall mortality.
Conclusions:
- The proposed MAC score provides a systematic classification of MAC severity.
- This classification is valuable for predicting prognosis in patients undergoing MV surgery.
- Severe MAC, as defined by the MAC score, is associated with increased long-term mortality.
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