%0 Journal Article
%T Staging Extramitral Cardiac Damage in Mitral Annular Calcification With Mitral Valve Dysfunction.
%A Al-Abcha A
%A Abbasi M
%A El-Am E
%A Ghorbanzadeh A
%A Lee A
%A Scott CG
%A Thaden JJ
%A Eleid M
%A Rihal C
%A Oh J
%A Pellikka PA
%A Guerrero ME
%J JACC Cardiovasc Interv
%V 17
%N 13
%D 2024 Jul 8
%M 38986657
%F 11.075
%R 10.1016/j.jcin.2024.05.031
%X <B>BACKGROUND: </B>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.<BR><B>OBJECTIVE: </B>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.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>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.