Abstract：
BACKGROUND: Mitral annular calcification (MAC) is a progressive degenerative process associated with comorbidities and increased mortality. A staging system that considers extramitral cardiac damage in MAC may help improve patient selection for mitral valve interventions.
OBJECTIVE: This study sought to develop a transthoracic echocardiogram (TTE)-based cardiac staging system in patients with MAC and significant mitral valve dysfunction and assess its prognostic utility.
METHODS: We retrospectively evaluated all adults who underwent TTE over 1 year at Mayo Clinic with MAC and significant mitral valve dysfunction defined as mitral stenosis and/or at least moderate mitral regurgitation. Patients were categorized into 5 stages according to extramitral cardiac damage by TTE. All-cause mortality and heart failure hospitalization were assessed.
RESULTS: For the 953 included patients, the mean age was 76.2 ± 10.7 years, and 54.0% were women. Twenty-eight (2.9%) patients were classified in stages 0 to 1, 499 (52.4%) in stage 2, 115 (12.1%) in stage 3, and 311 (32.6%) in stage 4. At the 3.8-year follow-up, mortality was significantly higher in patients in stages 2 to 4 compared to stages 0 to 1 and increased with each stage. Survival differences were maintained after adjustment for age, diabetes mellitus, and glomerular filtration rate. The rate of heart failure hospitalization was significantly higher in stages 3 and 4 compared to stages 0 to 1. Similar results were observed in subgroup analysis in patients with moderate or severe MAC, predominant mitral stenosis, or predominant mitral regurgitation.
CONCLUSIONS: Using the proposed extramitral cardiac damage staging system in patients with MAC and significant mitral valve dysfunction, more advanced stages are associated with higher mortality.
OBJECTIVE: This study sought to develop a transthoracic echocardiogram (TTE)-based cardiac staging system in patients with MAC and significant mitral valve dysfunction and assess its prognostic utility.
METHODS: We retrospectively evaluated all adults who underwent TTE over 1 year at Mayo Clinic with MAC and significant mitral valve dysfunction defined as mitral stenosis and/or at least moderate mitral regurgitation. Patients were categorized into 5 stages according to extramitral cardiac damage by TTE. All-cause mortality and heart failure hospitalization were assessed.
RESULTS: For the 953 included patients, the mean age was 76.2 ± 10.7 years, and 54.0% were women. Twenty-eight (2.9%) patients were classified in stages 0 to 1, 499 (52.4%) in stage 2, 115 (12.1%) in stage 3, and 311 (32.6%) in stage 4. At the 3.8-year follow-up, mortality was significantly higher in patients in stages 2 to 4 compared to stages 0 to 1 and increased with each stage. Survival differences were maintained after adjustment for age, diabetes mellitus, and glomerular filtration rate. The rate of heart failure hospitalization was significantly higher in stages 3 and 4 compared to stages 0 to 1. Similar results were observed in subgroup analysis in patients with moderate or severe MAC, predominant mitral stenosis, or predominant mitral regurgitation.
CONCLUSIONS: Using the proposed extramitral cardiac damage staging system in patients with MAC and significant mitral valve dysfunction, more advanced stages are associated with higher mortality.
摘要：
背景：二尖瓣环钙化（MAC）是与合并症和死亡率增加相关的进行性变性过程。在MAC中考虑二尖瓣外心脏损伤的分期系统可能有助于改善患者对二尖瓣介入的选择。
目的：本研究旨在开发一种基于经胸超声心动图（TTE）的心脏分期系统，用于患有严重二尖瓣功能障碍的MAC患者，并评估其预后效用。
方法：我们回顾性评估了所有在Mayo诊所接受TTE治疗超过1年的患者，患者患有MAC和严重的二尖瓣功能障碍，定义为二尖瓣狭窄和/或至少中度二尖瓣反流。根据TTE的二尖瓣外心脏损害将患者分为5个阶段。评估全因死亡率和心力衰竭住院率。
结果：对于953名患者，平均年龄为76.2±10.7岁，女性占54.0%。28例（2.9％）患者分为0至1期，2期为499例（52.4％），3期为115例（12.1％），4期为311例（32.6％）。在3.8年的随访中，2~4期患者的死亡率明显高于0~1期患者,且死亡率随各阶段增加而增加.生存差异在调整年龄后保持不变，糖尿病,和肾小球滤过率。与0至1阶段相比，第3阶段和第4阶段的心力衰竭住院率明显更高。在中度或重度MAC患者的亚组分析中观察到类似的结果，显性二尖瓣狭窄,或主要的二尖瓣反流。
结论：在MAC和显著二尖瓣功能障碍的患者中使用拟议的二尖瓣外心脏损伤分期系统，更晚期与更高的死亡率相关.
目的：本研究旨在开发一种基于经胸超声心动图（TTE）的心脏分期系统，用于患有严重二尖瓣功能障碍的MAC患者，并评估其预后效用。
方法：我们回顾性评估了所有在Mayo诊所接受TTE治疗超过1年的患者，患者患有MAC和严重的二尖瓣功能障碍，定义为二尖瓣狭窄和/或至少中度二尖瓣反流。根据TTE的二尖瓣外心脏损害将患者分为5个阶段。评估全因死亡率和心力衰竭住院率。
结果：对于953名患者，平均年龄为76.2±10.7岁，女性占54.0%。28例（2.9％）患者分为0至1期，2期为499例（52.4％），3期为115例（12.1％），4期为311例（32.6％）。在3.8年的随访中，2~4期患者的死亡率明显高于0~1期患者,且死亡率随各阶段增加而增加.生存差异在调整年龄后保持不变，糖尿病,和肾小球滤过率。与0至1阶段相比，第3阶段和第4阶段的心力衰竭住院率明显更高。在中度或重度MAC患者的亚组分析中观察到类似的结果，显性二尖瓣狭窄,或主要的二尖瓣反流。
结论：在MAC和显著二尖瓣功能障碍的患者中使用拟议的二尖瓣外心脏损伤分期系统，更晚期与更高的死亡率相关.
