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Mitral Annular Calcification: Natural History, Prognosis, and Clinical Outcomes
Gustavo Mendez-Hirata1, Christian W Schmidt1, Hanad I Bashir1
1The Christ Hospital Heart and Vascular Institute, The Lindner Center for Research and Education, Cincinnati, Ohio.
Journal of the Society for Cardiovascular Angiography & Interventions
|September 29, 2025
Summary
Mitral annular calcification (MAC) with mitral valve dysfunction (MVD) significantly increases mortality risk. Early identification and management of MVD in MAC patients are crucial for improving outcomes.
Area of Science:
- Cardiology
- Valvular Heart Disease
- Medical Imaging
Background:
- Mitral annular calcification (MAC) is a progressive degenerative condition affecting the mitral valve annulus.
- It involves calcium and lipid deposition, potentially leading to mitral valve dysfunction (MVD).
Purpose of the Study:
- To describe the natural history of patients diagnosed with MAC.
- To compare outcomes in MAC patients with and without MVD.
Main Methods:
- Observational study of 15,372 patients with echocardiogram-diagnosed MAC (2006-2023).
- 1:1 matching with control patients without MAC based on age and sex.
- Primary endpoint: all-cause mortality; secondary: predictors of mortality in MAC with MVD.
Main Results:
- Patients with MAC exhibited higher rates of comorbidities, cardiovascular risk factors, and multivalvular heart disease.
- Two-year mortality rates were significantly higher for MAC patients with MVD (26% for mitral regurgitation, 21% for mitral stenosis) compared to those without MVD (14%).
- Mitral regurgitation was more common than mitral stenosis in MAC patients with MVD.
Conclusions:
- Clinically significant MVD affects approximately 10% of patients with MAC.
- The presence of MVD is a significant independent predictor of increased mortality in patients with MAC.
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