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Updated: Jan 25, 2026

An Image Guided Transapical Mitral Valve Leaflet Puncture Model of Controlled Volume Overload from Mitral Regurgitation in the Rat
Published on: May 19, 2020
Impact of Left Atrial Strain on Severe Mitral Regurgitation Due to Mitral Annular Calcification
Mohammad Al Zein1, Yuichiro Okushi1, Shinya Unai2
1Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Background:
Mitral annular calcification (MAC) is a progressive degenerative condition characterized by calcium deposition on the mitral apparatus, and is associated with adverse outcomes. Data on mitral regurgitation (MR) caused by MAC are limited.
Objectives:
This study evaluates the prognostic significance of left atrial strain (LAS) in patients with severe MR due to MAC.
Methods:
We conducted a retrospective, single-center cohort study including patients with isolated severe MR due to MAC. Clinical data were retrieved, and the primary outcome was all-cause mortality. Echocardiographic parameters including LAS were recorded. The cohort was stratified by the median reservoir LAS (LASr).
Results:
Between January 2010 and August 2023, 128 patients with isolated severe MR due to MAC were identified and followed for a median of 134 days (IQR: 33-1,812 days). The median age was 81 years (IQR: 71-88), and 93/128 patients (72.7%) were females. A total of 45/128 patients underwent mitral valve (MV) intervention, whereas 83/128 received conservative management. During follow-up, 63/128 patients died. Patients with LASr ≤13.6% had significantly poorer outcomes (P = 0.031), whereas MV intervention improved survival across the spectrum of LASr (P < 0.05). In multivariate Cox analysis, mortality risk increased as LASr worsened (HR: 1.054; 95% CI: 1.002-1.109), whereas MV intervention improved prognosis (HR: 0.173; 95% CI: 0.075-0.397).
Conclusions:
LASr is associated with all-cause mortality in patients with isolated severe MR due to MAC and can serve as a valuable prognostic imaging marker for risk stratification. MV intervention improves prognosis across the spectrum of LASr.
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