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Calcification of Vascular Smooth Muscle Cells and Imaging of Aortic Calcification and Inflammation
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Pearls and pitfalls in the diagnosis and management of mitral annular calcification

Sebastiaan Dhont1,2,3, Gitte P H van den Acker3, Timothy W Churchill4

  • 1Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.

Heart (British Cardiac Society)
|January 20, 2026
PubMed

Insights

Mitral annular calcification (MAC) is a growing cause of mitral stenosis, impacting heart function and increasing cardiovascular risk. Early diagnosis and management are key, prioritizing medical therapy and specialized interventions for severe cases.

Area of Science:

  • Cardiology
  • Valvular Heart Disease
  • Biomedical Engineering

Background:

  • Mitral annular calcification (MAC) is a progressive degenerative condition with significant clinical implications.
  • MAC is now the leading cause of mitral stenosis in developed nations, surpassing rheumatic heart disease.
  • It contributes to mitral valve dysfunction, arrhythmias, systemic embolization, and increased cardiovascular risk.

Purpose of the Study:

  • To review the clinical impact, pathophysiology, diagnosis, and management of MAC.
  • To highlight the challenges in diagnosing MAC-related valve dysfunction and the importance of multimodality imaging.
  • To discuss current management strategies and potential future therapeutic advances.

Main Methods:

  • Literature review of studies on MAC, focusing on pathophysiology, diagnosis, and management.
  • Analysis of diagnostic challenges and the role of advanced imaging techniques like 3D echocardiography and cardiac CT.
  • Evaluation of current treatment approaches, including medical therapy and interventional procedures.

Main Results:

  • MAC pathophysiology involves mechanical stress, inflammation, and osteogenic differentiation, accelerated by age, CKD, and metabolic issues.
  • Traditional echocardiography is often unreliable for diagnosing MAC-related dysfunction; multimodality imaging is crucial.
  • Symptoms may stem from combined valvular and myocardial disease, requiring careful hemodynamic assessment.

Conclusions:

  • Management of MAC should prioritize medical therapy for symptoms and comorbidities like HFpEF.
  • Interventional approaches (surgical, transcatheter) are high-risk and reserved for selected patients in specialized centers.
  • Future research may focus on therapies targeting calcification pathways and tailored devices.

Keywords:
Heart Failure, DiastolicMitral Valve Stenosis

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