| Affiliation: | 1. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN;2. Department of Health Sciences Research, Mayo Clinic, Rochester, MN;1. Department of Gastroenterology and Hepatology, Mie University Hospital, Tsu, Japan;2. Department of Pathology, Mie University Hospital, Tsu, Japan;1. Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Jacksonville, FL;2. Advisor to residents and Consultant in Internal Medicine, Mayo Clinic, Jacksonville, FL;1. Département de Cardiologie, CHU Timone, Marseille, France;2. Aix Marseille Univ, Inserm, Inra, C2VN, Marseille, France;3. Aix-Marseille Université, Faculté de Médecine, Marseille, France;4. Service de Chirurgie Cardiaque, Centre Hospitalier Universitaire et Faculté de Médecine, Université de Tours, France;5. Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université de Tours, France;6. Service d''information médicale, d''épidémiologie et d''économie de la santé, Centre Hospitalier Universitaire et Faculté de Médecine, EA7505, Université de Tours, France;7. Département de Chirurgie Cardiaque, CHU Timone, Marseille, France;1. Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN;2. Division of General Internal Medicine, Mayo Clinic, Rochester, MN;3. Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, MN;4. Department of Medicine, Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN;5. Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN;6. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN;7. Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN;8. Department of Medicine, Staten Island University Hospital, Staten Island, NY;9. Department of Medicine, Rosalind Franklin University Hospital, Chicago, IL;10. Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA;11. Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta;12. Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC |
| Abstract: | ObjectiveTo evaluate the prevalence and natural history of mitral annulus calcification (MAC) and associated mitral valve dysfunction (MVD) in patients undergoing clinically indicated echocardiography.MethodsA retrospective review was conducted of all adults who underwent echocardiography in 2015. Mitral valve dysfunction was defined as mitral regurgitation or mitral stenosis (MS) of moderate or greater severity. All-cause mortality during 3.0 (0.4 to 4.2) years of follow-up was compared between groups stratified according to the presence of MAC or MVD.ResultsOf 24,414 evaluated patients, 5502 (23%) had MAC. Patients with MAC were older (75±10 years vs 60±16 years; P<.001) and more frequently had MVD (MS: 6.6% vs 0.5% P<.001]; mitral regurgitation without MS: 9.5% vs 6.1% P<.001]). Associated with MS in patients with MAC were aortic valve dysfunction, female sex, chest irradiation, renal dysfunction, and coronary artery disease. Kaplan-Meier 1-year survival was 76% in MAC+/MVD+, 87% in MAC+/MVD?, 86% in MAC?/MVD+, and 92% in MAC?/MVD?. Adjusted for age, diabetes, renal dysfunction, cancer, chest irradiation, ejection fraction below 50%, aortic stenosis, tricuspid regurgitation, and pulmonary hypertension, MAC was associated with higher mortality during follow-up (adjusted hazard ratio, 1.40; 95% CI, 1.31 to 1.49; P<.001); MVD was associated with even higher mortality in patients with MAC (adjusted hazard ratio, 1.79; 95% CI, 1.58 to 2.01; P<.001). There was no significant interaction between MAC and MVD for mortality (P=.10).ConclusionIn a large cohort of adults undergoing echocardiography, the prevalence of MAC was 23%. Mitral valve dysfunction was more than twice as prevalent in patients with MAC. Adjusted mortality was increased in patients with MAC and worse with both MAC and MVD. |
