Impact of Mitral Annular Calcium on Outcomes after Transcatheter Aortic Valve Implantation

Ancona, Marco; Giannini, Francesco; Mangieri, Antonio; Regazzoli, Damiano; Jabbour, Richard J.; Tanaka, Akihito; Testa, Luca; Romano, Vittorio; Longoni, Matteo; Giglio, Manuela; Besana, Francesca; Cacucci, Michele; Agricola, Eustachio; Chieffo, Alaide; Alfieri, Ottavio; Montorfano, Matteo; Colombo, Antonio; Latib, Azeem

doi:10.1016/j.amjcard.2017.09.006

Cited by 25 publications

(20 citation statements)

References 22 publications

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“…14,16,29 The presence of MAC has been related to a higher risk of cardiovascular events, cardiovascular death, and all-cause mortality. 5,6,9 For outcome studies, subjective semi-quantitative MAC assessment on contrast-enhanced CT with different methods were described, 5,6,17,18 which limit the comparability among these studies. Using one of these previously introduced subjective scoring systems 18 we found a substantial to almost perfect agreement between four readers in patients having either no or severe MAC.…”

Section: Tablementioning

confidence: 99%

“…However, the presence of MAC has been associated with a higher risk of cardiovascular events and mortality, conduction abnormalities, and mitral valve disease. [5][6][7][8][9] In addition, extensive MAC represents a challenge for surgery when mitral valve repair or replacement is planned. 10 On the contrary, extensive and circumferential MAC can act as an anchor for positioning balloonexpandable valves in the mitral position.…”

Section: Introductionmentioning

confidence: 99%

“…3,[14][15][16] All studies evaluating the prognostic effect of MAC on outcome so far applied a subjective, semi-quantitative scoring system of MAC on contrast-enhanced CT using different methods. 5,6,17,18 For example the method described by Amat-Santos et al 5,18 used a 4-grade scoring system evaluating the circumferential involvement of the mitral annulus, whereas involvement of ≥1/2 of the circumference represents severe MAC. Ancona et al 6 used a 5-grade scoring system evaluating the extent of posterior involvement as grade 0-3 and extension to the anterior annulus as grade 4.…”

Section: Introductionmentioning

confidence: 99%

“…5,6,17,18 For example the method described by Amat-Santos et al 5,18 used a 4-grade scoring system evaluating the circumferential involvement of the mitral annulus, whereas involvement of ≥1/2 of the circumference represents severe MAC. Ancona et al 6 used a 5-grade scoring system evaluating the extent of posterior involvement as grade 0-3 and extension to the anterior annulus as grade 4. Takana et al 17 also used a 5-grade scoring system with grades representing the involvement of 0, < 1/4, < 1/2, < 3/4 and > 3/4 of the entire annular circumference.…”

Section: Introductionmentioning

confidence: 99%

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Mitral annular calcification in the elderly – Quantitative assessment

Eberhard

Schönenberger

Hinzpeter

et al. 2021

Journal of Cardiovascular Computed Tomography

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To determine the reliability of subjective and objective quantification of mitral annular calcification (MAC) in elderly patients with severe aortic stenosis, to define quantitative sex-and age-related reference values of MAC, and to correlate quantitative MAC with mitral valve disease. Methods: In this retrospective, IRB-approved study, we included 559 patients (268 females, median age 81 years, inter-quartile range 77-85 years) with severe aortic stenosis undergoing CT. Four independent readers performed subjective MAC categorization as follows: no, mild, moderate, and severe MAC. Two independent readers performed quantitative evaluation of MAC using the Agatston score method (Agatston MAC). Mitral valve disease was determined by echocardiography. Results: Subjective MAC categorization showed high inter-reader agreement for no (k = 0.88) and severe MAC (k = 0.75), whereas agreement for moderate (k = 0.59) and mild (k = 0.45) MAC was moderate. Intra-reader agreement for subjective MAC categorization was substantial (k = 0.69 and 0.62). Inter-and intra-reader agreement for Agatston MAC were excellent (ICC = 0.998 and 0.999, respectively), with minor inconsistencies in MAC involving the left ventricular outflow tract/aortic valve. There were significantly more women than men with MAC (n = 227, 85% versus n = 209, 72%; p < 0.001), with a significantly higher Agatston MAC (median 597, range 81-2055 versus median 244; range 0-1565; p < 0.001), particularly in patients ≥85 years of age. Agatston MAC showed an area-under-the-curve of 0.84 to diagnose mitral stenosis, whereas there was no association of Agatston MAC with mitral regurgitation (p > 0.05). Conclusions: Our study in elderly patients with severe aortic stenosis shows that quantitative MAC scoring is more reliable than subjective MAC assessment. Women show higher Agatston MAC scores than men, particularly in the elderly population. Agatston MAC shows high accuracy to diagnose mitral stenosis.

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Section: Tablementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mitral annular calcification in the elderly – Quantitative assessment

Eberhard

Schönenberger

Hinzpeter

et al. 2021

Journal of Cardiovascular Computed Tomography

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“…Severe mitral annular calcification (MAC) has a prevalence of 9 to 18% in patients undergoing transcatheter aortic valve replacement (TAVR) and has been independently associated with increased mortality (1,2). MAC often coexists with, or results in mitral regurgitation (MR) or mitral stenosis (MS) (1,(3)(4)(5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Does isolated mitral annular calcification in the absence of mitral valve disease affect clinical outcomes after transcatheter aortic valve replacement?

Okuno

Asami

Khan

et al. 2019

European Heart Journal - Cardiovascular Imaging

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Aims Mitral annular calcification (MAC) has been associated with adverse outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) but has been investigated in isolation of co-existent mitral regurgitation or mitral stenosis, which may represent important confounders. This study sought to investigate the effect of MAC with and without concomitant mitral valve disease (MVD) on clinical outcomes in patients treated with TAVR. Methods and results Computed tomography (CT) and echocardiographic data in consecutive TAVR patients enrolled into a prospective registry were categorized according to presence or absence of severe MAC and significant MVD, respectively. A total of 967 patients with adequate CT and echocardiography data were included between 2007 and 2017. Severe MAC was found in 172 patients (17.8%) and associated with MVD in 87 patients (50.6%). Compared to TAVR patients without severe MAC or MVD, all-cause mortality at 1 year was significantly increased among patients with severe MAC in combination with MVD [adjusted hazard ratio (HRadj): 1.97, 95% confidence interval (CI): 1.12–3.44, P = 0.018] and patients with isolated MVD (HRadj: 2.33, 95% CI: 1.56–3.47, P < 0.001), but not in patients with isolated severe MAC in the absence of MVD (HRadj: 0.52, 95% CI: 0.21–1.33, P = 0.173). Conclusion We found no effect of isolated MAC on clinical outcomes following TAVR in patients with preserved mitral valve function. Patients with MVD had an increased risk of death at 1 year irrespective of MAC.

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