Mitral Annular Calcification: Association with Atherosclerosis and Clinical Implications

Cavalcanti, Luiz Rafael Pereira; Perazzo, Álvaro Monteiro; Neto, Amadeu Lombardi; Gomes, Rafael Alessandro Ferreira; Weymann, Alexander; Zhigalov, Konstantin; Ruhparwar, Arjang; Lima, Ricardo Carvalho

doi:10.1007/s11883-020-0825-3

Cited by 13 publications

(10 citation statements)

References 79 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

Section: Discussionmentioning

confidence: 99%

“…Recent studies reported that MAC is an active and controlled molecular event associated with microscopic and macroscopic injury, lipid deposition, hemodynamic stress, chronic kidney disease, dysregulated bone and mineral metabolism regulators, and local inflammation 21,22 . Baseline MAC burden was also related to disease activity and disease progression rates 21 . MAC appears to induce anatomical changes which culminate in either MS or combined MS and MR, while MS in severe MAC settings is caused by encroaching orifice areas, and rheumatic MS arises due to an absence of leaflet commissural union 23 .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Noncontrast cardiac computed tomography‐derived mitral annular calcification scores in mitral valve disease

Hou

Sun

Wang

et al. 2023

Clinical Cardiology

View full text Add to dashboard Cite

Background and AimsMitral annular calcification (MAC) by computed tomography (CT) is reported as an independent predictor of poor outcomes. However, it currently remains unclear if quantitative MAC parameters provide more value for mitral valve disease (MVD) management, therefore, we examined the prognostic value of MAC scores using noncontrast cardiac‐CT in MVD patients.MethodsBetween January 2020 and December 2021, we prospectively enrolled 300 consecutive patients with MVD (MAC‐present = 80 and MAC‐absent = 220) undergoing preoperative cardiac‐CT and mitral valve (MV) surgery. Noncontrast cardiac‐CT images were used to qualitatively detect MAC (present or absent) and evaluate MAC scores. For analyses, we also collected baseline clinical data, intraoperative conversion (from MV repair to MV replacement), and follow‐up arrhythmia data.ResultsCompared with the MAC‐absent group, MAC‐present patients were older (62 ± 7 vs. 58 ± 9 years, p < .001), mostly women (55% vs. 39.5%, p = .017), and also had aortic valve calcification (57.5% vs. 23.2%, p < .001), mitral stenosis (82.5% vs. 61.8%, p < .001), atrial fibrillation (30% vs. 11.8%, p < .001), and larger left atrial end‐diastolic dimension (LADD, 49 [44–56] versus 46 [41–50], p = .001]. Furthermore, MAC‐present patients underwent more MV replacements (61.8% vs. 82.5%, p = .001) and experienced a higher intraoperative conversion prevalence (11.8% vs. 61.3%, p < .001). Multiple logistic regression analyses showed that the female gender (odds ratio [OR]/95% confidence interval [CI]/p = 2.001/1.042–3.841/0.037) and MAC scores (OR/95% CI/p = 10.153/4.434–23.253/p < .001) were independent predictors of intraoperative conversion. During a follow‐up of 263 ± 134 days, MAC‐present patients had more arrhythmias (42.5% vs. 9.5%, p < .001). Also, MAC‐scores (hazard ratio [HR]/95% CI/p = 6.841/3.322–14.089/p < .001) and LADD (HR/95% CI/p = 1.039/1.018–1.060/p < .001) were independently associated with arrhythmias by Cox regression analyses.ConclusionsNoncontrast cardiac CT‐derived MAC‐scores showed a high risk for intraoperative conversion and follow‐up arrhythmias in MVD‐patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Noncontrast cardiac computed tomography‐derived mitral annular calcification scores in mitral valve disease

Hou

Sun

Wang

et al. 2023

Clinical Cardiology

View full text Add to dashboard Cite

show abstract

“…For mitral valve calcification, processes similar to those for aortic valve calcification are believed to play a role [7,32]. Additionally, microinjuries, shear stress, and turbulent flow are considered important initiators of calcification as these act as stimuli for endothelial inflammation [32].…”

Section: Discussionmentioning

confidence: 99%

“…Aortic and mitral valve calcification has increasing prevalence with age, and due to higher life expectancies in the future, prevalence is expected to rise even further [1,2]. Both aortic and mitral valve calcifications may impact risk of heart valve disease and death [3][4][5][6][7]. Risk factors for aortic valve calcification and disease include male sex, smoking, age, blood pressure, low-density cholesterol, chronic kidney disease and body mass index whereas risk factors for mitral valve calcification and disease are less studied [8][9][10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Elevated lipoprotein(a) in mitral and aortic valve calcification and disease: The Copenhagen General Population Study

et al. 2022

View full text Add to dashboard Cite

Background and aims: We tested the hypotheses (i) that elevated lipoprotein(a) is causally associated with both mitral and aortic valve calcification and disease, and (ii) that aortic valve calcification mediates the effect of elevated lipoprotein(a) on aortic valve stenosis. Methods: From the Copenhagen General Population study, we included 12,006 individuals who underwent cardiac computed tomography to measure mitral and aortic valve calcification and 85,884 to examine risk of heart valve disease. Participants had information on plasma lipoprotein(a) and genetic instruments associated with plasma lipoprotein(a) to investigate potential causality. Results: At age 70-79 years, 29% and 54% had mitral and aortic valve calcification, respectively. For 10-fold higher lipoprotein(a) levels, multifactorially adjusted odds ratios for mitral and aortic valve calcification were 1.26 (95% confidence interval: 1.13-1.41) and 1.62 (1.48-1.77). For mitral and aortic valve stenosis, corresponding hazard ratios were 0.93 (95%CI:0.40-2.15, 19 events) and 1.54 (1.38-1.71, 1158 events), respectively. For ≤23 versus ≥36 kringle IV type 2 number of repeats, the age and sex adjusted odds ratios for mitral and aortic valve calcification were 1.53 (1.18-1.99) and 2.23 (1.81-2.76). For carriers versus non-carriers of LPA rs10455872, odds ratios for mitral and aortic valve calcification were 1.33 (1.13-1.57) and 1.86 (1.64-2.13). For aortic valve stenosis, 31% (95%CI:16%-76%) of the effect of lipoprotein(a) was mediated through calcification. Conclusions: Elevated lipoprotein(a) was genetically and observationally associated with mitral and aortic valve calcification and aortic valve stenosis. Aortic valve calcification mediated 31% of the effect of elevated lipoprotein(a) on aortic valve stenosis.

show abstract

“…MAC represents a chronic degenerative process in the fibrous base of the MV and more commonly affects the posterior rather than the anterior annulus [ 1 ]. MAC may be initiated by factors such as shear stress passing the MV, inflammation and dysregulation of regulators of mineral metabolism [ 9 ]. Calcification was often seen at the ventricular portion of the annulus between the left ventricular myocardium and the leaflet base because the highest mechanical shear forces occur in that area and at the same time the leaflet base contacts the myocardium in each diastole.…”

Section: Discussionmentioning

confidence: 99%

Extensive calcification of the mitral valve annulus in transcatheter aortic valve implants

Haensig

Kuntze

Gonzalez

et al. 2021

Interactive CardioVascular and Thoracic Surgery

View full text Add to dashboard Cite

OBJECTIVES This study sought to report the calcification pattern of the mitral valve annulus and its implications for procedural and safety outcomes in transcatheter aortic valve implantation. METHODS Between November 2018 and September 2019, a total of 305 patients had transcatheter aortic valve implants at our institution. The extent of calcification of the mitral valve annulus was analysed, and the impact on safety outcomes was evaluated. RESULTS The prevalence of mitral annular calcification (MAC) was 43%. Calcification of the mitral valve annulus was either less than or at least one-third of the posterior annulus (34% and 32%), the whole posterior annulus (28%) or the extension to the attachment of the anterior leaflets (7%). Severe circumferential MAC revealed moderate paravalvular leaks in 5/8 (63%) patients and was associated with right branch bundle block [odds ratio (OR) 2.01 (0.39–3.06); P = 0.098] and low cardiac output [OR 3.12 (1.39–7.04); P = 0.033]. Subannular calcification at the anterolateral trigonum represented a risk factor for left ventricular outflow tract injury [OR 3.54 (1.38–8.27); P = 0.001] in balloon-expandable valves, associated with relevant rhythm disorders [OR 2.26 (1.17–5.65); P = 0.014] and female gender (7/8, 88%). The 30-day all-cause mortality in circumferential MAC reaching into the anterior annulus (grade IV) compared to patients with less MAC (grade I–III) was 13% vs 2% with a mean valve size of 24.6 vs 25.7 mm. CONCLUSIONS Extensive MAC was associated with moderate paravalvular leaks, with implications for the prosthesis size and survival in transcatheter aortic valve implants. In severe MAC, we recommend implanting oversized self-expandable prostheses, the goal being to reduce the risk of right branch bundle block and paravalvular leaks. Subj collection 122, 125

show abstract

Mitral Annular Calcification: Association with Atherosclerosis and Clinical Implications

Cited by 13 publications

References 79 publications

Noncontrast cardiac computed tomography‐derived mitral annular calcification scores in mitral valve disease

Noncontrast cardiac computed tomography‐derived mitral annular calcification scores in mitral valve disease

Elevated lipoprotein(a) in mitral and aortic valve calcification and disease: The Copenhagen General Population Study

Extensive calcification of the mitral valve annulus in transcatheter aortic valve implants

Contact Info

Product

Resources

About