Mitral Annulus Calcification and Cardiac Conduction Disturbances: A DANCAVAS Sub-study

Abstract

BACKGROUND Due to its location very close to the bundle of His, mitral annulus calcification (MAC) might be associated with the development of atrioventricular (AV) conduction disturbances. This study assessed the association between MAC and AV conduction disturbances identified by cardiac implantable electronic device (CIED) use and electrocardiographic parameters. The association between MAC and traditional cardiovascular risk factors was also assessed. METHODS This cross-sectional study analyzed 14,771 participants, predominantly men aged 60–75 years, from the population-based Danish Cardiovascular Screening trial. Traditional cardiovascular risk factors were obtained. Using cardiac non-contrast computed tomography imaging, MAC scores were measured using the Agatston method and divided into absent versus present and score categories. CIED implantation data were obtained from the Danish Pacemaker and Implantable Cardioverter Defibrillator Register. A 12-lead electrocardiogram was available for 2,107 participants. Associations between MAC scores and AV conduction disturbances were assessed using multivariate regression analyses. RESULTS MAC was present in 22.4% of the study subjects. Participants with pacemakers for an AV conduction disturbance had significantly higher MAC scores (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.01–1.23) than participants without a CIED, whereas participants with a CIED for other reasons did not. Prolonged QRS-interval was significantly associated with the presence of MAC (OR, 1.45; 95% CI, 1.04–2.04), whereas prolonged PQ-interval was not. Female sex and most traditional cardiovascular risk factors were significantly associated with high MAC scores. CONCLUSIONS MAC was associated with AV conduction disturbances, which could improve our understanding of the development of AV conduction disturbances.

Risk Factors and Outcomes With Progressive Mitral Annular Calcification

“…The concept of MAC progression is generally accepted because MAC is a disease of degenerative nature. In fact, several studies have demonstrated the risk factors for MAC occurrence and their clinical significance regarding all‐cause mortality and stroke, 4 , 5 , 7 , 9 , 15 , 16 , 17 , 18 , 19 , 20 , 21 Recently, Kato et al 22 , 23 also demonstrated that the prevalence of MAC was 23% in 24 414 patients. Patients with MAC had a higher risk of mortality, worse outcomes, and mitral valve dysfunction.…”

Implications of Mitral Annular Calcification on Outcomes Following Mitral Transcatheter Edge-to-Edge Repair

“…Affecting up to 24.1% of patients referred to surgical mitral regurgitation (MR) repair, 1 MAC is now regarded as a correlate of numerous disease processes, most of which share an increased atherosclerotic hazard. 2,3 Also, it has been linked to adverse valvular 4 and arrhythmic sequelae, 5,6 as well as to a more complex MV surgical course. 7 Currently, there are scarce data concerning the clinical implications of MAC extent in the ever-expanding mitral transcatheter edge-to-edge repair (TEER) population.…”