Mitral annular calcification in obstructive hypertrophic cardiomyopathy: Incidence, risk factors, and prognostic value after myectomy

Zining Wu; Changrong Nie; Changsheng Zhu; Yanhai Meng; Qiulan Yang; Tao Lu; Zhengyang Lu; Xiaoxi Liu; Shuiyun Wang

doi:10.1016/j.ijcard.2023.131266

Mitral annular calcification in obstructive hypertrophic cardiomyopathy: Incidence, risk factors, and prognostic value after myectomy

Int J Cardiol. 2023 Nov 15:391:131266. doi: 10.1016/j.ijcard.2023.131266. Epub 2023 Aug 11.

Authors

Zining Wu¹, Changrong Nie², Changsheng Zhu², Yanhai Meng³, Qiulan Yang³, Tao Lu², Zhengyang Lu², Xiaoxi Liu², Shuiyun Wang⁴

Affiliations

¹ Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address: wuzining66@sina.com.
² Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
³ Department of Adult Intensive Care Unit, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁴ Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address: wsymd@sina.com.

PMID: 37574021
DOI: 10.1016/j.ijcard.2023.131266

Abstract

Background: Mitral annular calcification (MAC) is a risk factor for cardiac surgery, but there is limited study on the prognosis value and the impact for valve function of MAC based on computed tomography (CT) diagnosis after myectomy for hypertrophic obstructive cardiomyopathy (OHCM).

Methods: Consecutive OHCM patients underwent septal myectomy were compared according to the existence of MAC and its severity in preoperative CT scans. The survival data were evaluated and compared by Kaplan Meier analysis and log rank test. Cox regression analysis was used to evaluate the impact of MAC on endpoint events.

Results: From the entire cohort of 1035 patients, 10.8% had MAC. In multivariate regression, female (OR = 2.23), age (OR = 1.07), aortic annular calcification (OR = 2.52), aortic calcification (OR = 2.56), systolic anterior motion of the mitral valve (SAM) (OR = 0.42), mitral valve thickening (OR = 2.13), and tricuspid regurgitation (OR = 3.12) were independent predictors of MAC. All-cause mortality (3.57% vs. 1.08%, p = 0.031), major adverse cardiovascular and cerebrovascular events (MACCE) (23.32% vs. 13.65%, p = 0.014), recurrent MR > 2+ (8.04% vs. 2.49%, p = 0.001) and NYHA III-IV (11.61% vs. 5.53%, p = 0.012) were more frequent in OHCM patients with MAC after myectomy. MAC was discovered to be an independent predictor of postoperative recurrent MR > 2+ after other risk factors were taken into account (HR 2.47, 95% CI 1.08-5.67, p = 0.0329). Moderate-to-severe MAC was an independent risk factor (HR 2.03, 95% CI 1.09-3.75, p = 0.0244) for long-term major adverse cardiovascular and cerebrovascular events (MACCE).

Conclusion: MAC was detected in one-tenth of OHCM patients in preoperative CT scanning and is mainly associated with aging and atherosclerosis. OHCM patients with MAC had a worse prognosis and more recurrent mitral valve regurgitation than those without MAC after septal myectomy.

Keywords: Hypertrophic obstructive cardiomyopathy; Mitral annulus calcification; Septal myectomy.

MeSH terms

Cardiomyopathy, Hypertrophic* / diagnostic imaging
Cardiomyopathy, Hypertrophic* / epidemiology
Cardiomyopathy, Hypertrophic* / surgery
Female
Humans
Incidence
Mitral Valve / diagnostic imaging
Mitral Valve / surgery
Mitral Valve Insufficiency* / diagnostic imaging
Mitral Valve Insufficiency* / epidemiology
Mitral Valve Insufficiency* / surgery
Prognosis
Treatment Outcome