open access

Vol 79, No 6 (2021)
Original article
Published online: 2021-04-29
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Association between calcifications of mitro-aortic continuity and mitral regurgitation in patients undergoing transcatheter aortic valve replacement

Małgorzata Ryś, Tomasz Hryniewiecki, Adam Witkowski, Ilona Michałowska, Karina Zatorska, Patrycjusz Stokłosa, Małgorzata Nieznańska, Piotr Szymański
DOI: 10.33963/KP.15987
·
Pubmed: 33926170
·
Kardiol Pol 2021;79(6):669-675.

open access

Vol 79, No 6 (2021)
Original article
Published online: 2021-04-29

Abstract

Background: The presence of mitral annular calcification (MAC) affects prognosis in patients undergoing transcatheter aortic valve implantation (TAVI). MAC frequently coexists with calcifications of mitro-aortic continuity (CMAC).
Aims: We aimed at qualitative and semi-quantitative analysis of calcifications of the mitral complex — MAC and CMAC in multi-slice computed tomography, in order to assess their impact on the occurrence and dynamics of mitral regurgitation (MR) following TAVI.
Methods: The study group consisted of 94 patients (mean [SD] age was 79.9 [8.02] years; 67.1% female). Agatston scale — Calcium Score was used for quantitative analysis. MAC and CMAC were also assessed semi-quantitatively as either non-severe or severe. MR following TAVI was defined as unchanged, improved or worsened by at least one degree.
Results: Patients with MAC (59.6%) had higher mean aortic gradients (P = 0.02) and smaller left ventricular diastolic diameter (P = 0.002). Patients with CMAC (48.9%) had higher Calcium Score aortic valve (P = 0.006). After TAVI MR improved in 17 (18.1%) patients and worsened in 7 (7.5%) patients. In multivariable logistic regression analysis MR worsening was associated with higher CMAC (OR, 1.092; 95% CI, 1.006–1.185; P = 0.03), as well as bicuspid aortic valve (OR, 6.348; 95% CI, 1.048–38.436; P = 0.04).
Conclusions: CMAC was associated with MR worsening following TAVI. This is of relevance in procedural planning in patients with severe aortic stenosis (AS) and coexisting MR in whom arguments for and against surgical repair of concomitant mitral insufficiency are considered.

Abstract

Background: The presence of mitral annular calcification (MAC) affects prognosis in patients undergoing transcatheter aortic valve implantation (TAVI). MAC frequently coexists with calcifications of mitro-aortic continuity (CMAC).
Aims: We aimed at qualitative and semi-quantitative analysis of calcifications of the mitral complex — MAC and CMAC in multi-slice computed tomography, in order to assess their impact on the occurrence and dynamics of mitral regurgitation (MR) following TAVI.
Methods: The study group consisted of 94 patients (mean [SD] age was 79.9 [8.02] years; 67.1% female). Agatston scale — Calcium Score was used for quantitative analysis. MAC and CMAC were also assessed semi-quantitatively as either non-severe or severe. MR following TAVI was defined as unchanged, improved or worsened by at least one degree.
Results: Patients with MAC (59.6%) had higher mean aortic gradients (P = 0.02) and smaller left ventricular diastolic diameter (P = 0.002). Patients with CMAC (48.9%) had higher Calcium Score aortic valve (P = 0.006). After TAVI MR improved in 17 (18.1%) patients and worsened in 7 (7.5%) patients. In multivariable logistic regression analysis MR worsening was associated with higher CMAC (OR, 1.092; 95% CI, 1.006–1.185; P = 0.03), as well as bicuspid aortic valve (OR, 6.348; 95% CI, 1.048–38.436; P = 0.04).
Conclusions: CMAC was associated with MR worsening following TAVI. This is of relevance in procedural planning in patients with severe aortic stenosis (AS) and coexisting MR in whom arguments for and against surgical repair of concomitant mitral insufficiency are considered.

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Keywords

aortic stenosis, calcification of mitro-aortic continuity, mitral annular calcification, mitral regurgitation, transcatheter aortic valve implantation

About this article
Title

Association between calcifications of mitro-aortic continuity and mitral regurgitation in patients undergoing transcatheter aortic valve replacement

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 79, No 6 (2021)

Article type

Original article

Pages

669-675

Published online

2021-04-29

DOI

10.33963/KP.15987

Pubmed

33926170

Bibliographic record

Kardiol Pol 2021;79(6):669-675.

Keywords

aortic stenosis
calcification of mitro-aortic continuity
mitral annular calcification
mitral regurgitation
transcatheter aortic valve implantation

Authors

Małgorzata Ryś
Tomasz Hryniewiecki
Adam Witkowski
Ilona Michałowska
Karina Zatorska
Patrycjusz Stokłosa
Małgorzata Nieznańska
Piotr Szymański

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