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Published on: August 28, 2018
Mitral Annular Calcification Score Determined by 3-D Transesophageal Echocardiography vs Cardiac Computed Tomography
Karol Quelal Analuisa1, Apurva Challa2, Conor Lane2
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: https://twitter.com/KarolQuelal.
Insights
Three-dimensional transesophageal echocardiography (3D-TEE) offers a complementary assessment of mitral annular calcification (MAC) severity, correlating with mitral stenosis. This technique may aid in transcatheter mitral valve replacement evaluations, particularly when CT contrast is limited.
Area of Science:
- Cardiology
- Medical Imaging
- Valvular Heart Disease
Background:
- Mitral annular calcification (MAC) severity is graded by cardiac computed tomography (CT) scoring.
- The correlation between CT-based MAC scoring and three-dimensional transesophageal echocardiography (3D-TEE) is not well-established.
Purpose of the Study:
- To compare MAC severity assessment between 3D-TEE and CT.
- To evaluate the association of MAC severity with hemodynamic parameters of mitral valve disease.
Main Methods:
- Analysis of 164 patients undergoing transcatheter mitral valve replacement screening from the MITRAL II trial.
- Assessment of MAC severity using both 3D-TEE and CT by core laboratories.
- Correlation and agreement analysis using Spearman and intraclass correlation coefficients.
- Evaluation of hemodynamic parameters from 2D-TTE and 3D-TEE using linear regression.
Main Results:
- A modest positive correlation (Spearman's rho = 0.34) was found between 3D-TEE and CT MAC scores, with better agreement in severe MAC.
- Increased 3D-TEE MAC scores correlated with decreased mitral valve area and increased mean diastolic pressure gradient, indicating mitral stenosis.
- 3D-TEE MAC scores did not significantly correlate with regurgitation parameters, and CT-MAC scores showed weak, nonsignificant correlations with both stenosis and regurgitation.
Conclusions:
- 3D-TEE provides a complementary and functionally relevant assessment of MAC severity.
- 3D-TEE correlates with mitral stenosis severity, making it a valuable tool in clinical practice.
- 3D-TEE can be a useful adjunct to CT for evaluating patients undergoing transcatheter mitral valve replacement, especially in cases with contrast limitations.
Background:
A cardiac computed tomography (CT)-based mitral annular calcification (MAC) scoring system systematically grades MAC severity, but its correlation with three-dimensional transesophageal echocardiography (3D-TEE) remains unclear.
Objectives:
The authors aimed to compare MAC severity assessment by 3D-TEE vs CT and evaluate their associations with hemodynamic parameters indicative of mitral valve disease.
Methods:
We analyzed patients with MAC enrolled in the MITRAL (Mitral Implantation of TRAnscathether vaLves) II trial (NCT04408430) across 13 centers undergoing transcatheter mitral valve replacement screening. Core laboratories assessed MAC severity using 3D-TEE and CT. Correlation and agreement were assessed via Spearman and intraclass correlation coefficients. Hemodynamic parameters of mitral stenosis (MS) and regurgitation were obtained from two-dimensional transthoracic echocardiography (2D-TTE) and 3D-TEE. Linear regression evaluated associations with MAC scores.
Results:
The analysis included 164 patients (75% females, mean age 75.5 ± 9.1 years). The mean MAC scores were 8.0 ± 0.44 by CT and 8.2 ± 0.45 by 3D-TEE. A modest positive correlation (Spearman correlation coefficient = 0.34; P < 0.001) was observed between 3D-TEE and CT scores, with better agreement in severe MAC. Each unit increase in the 3D-TEE MAC score was associated with a 0.15 cm2 decrease in 3D-TEE mitral valve area, a 0.05 cm2 decrease in 2D-TTE mitral valve area, and an increase in mean diastolic pressure gradient (1 mm Hg by 3D-TEE; 0.96 mm Hg by 2D-TTE). 3D-TEE MAC scores showed no significant correlation with regurgitation parameters. CT-MAC scores showed weak, nonsignificant correlations with both MS and mitral regurgitation.
Conclusions:
3D-TEE provides complementary and functionally relevant MAC assessment, correlating with MS severity. It may serve as a useful adjunct to CT in transcatheter mitral valve replacement evaluation, especially when contrast imaging is limited.
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