Mitral valve area was independently associated with all-cause mortality in patients with MAC-related mitral stenosis, who had an overall 5-year survival of 57% (adjusted HR 1.56; 95% CI 1.03-2.38).
Cohort (n=264)
Yes
Mitral annular calcification-related mitral stenosis carries a poor prognosis with a 5-year survival of 57%, and mitral valve area is an independent predictor of mortality in this high-risk population.
Effect estimate: adjusted HR 1.56 (95% CI 1.03-2.38)
BACKGROUND Mitral annular calcification (MAC)-related mitral stenosis is associated with increased mortality, but robust long-term outcomes remain unclear. OBJECTIVES The aim of this study was to investigate 5-year outcomes, including causes of death and valve-related prognostic factors, in patients with MAC-related mitral stenosis. METHODS The retrospective, multicenter JAMAC (Japan Multicenter Mitral Annular Calcification) study included adult patients from 11 Japanese centers who underwent echocardiography between 2016 and 2017 and had MAC with a transmitral mean gradient ≥5 mm Hg. Mitral stenosis etiology, mitral valve area (MVA), and anterior MAC in the parasternal long-axis view were evaluated. Posterior MAC was graded as mild (less than one-third), moderate (one-third to two-thirds), or severe (more than two-thirds) of the posterior mitral annular circumference in the parasternal short-axis view. The primary outcome was all-cause mortality; secondary outcomes were cardiac and noncardiac death. To determine valve-related prognostic factors, multivariable analysis was performed including key clinical variables. RESULTS Among 264 patients (median age 78 years; 73% female), 201 (76%) had calcific mitral stenosis and 63 (24%) had rheumatic mitral stenosis. Median MVA was 1.40 cm2, transmitral mean gradient was 6.1 mm Hg, and 63% had anterior MAC. Posterior MAC was severe in 47% and moderate in 25%. Five-year survival was 57%; cardiac and noncardiac mortality was 16% and 24%, respectively. Calcific mitral stenosis showed higher mortality compared with rheumatic mitral stenosis (cardiac death: 18% vs 11%; noncardiac death: 28% vs 13%). Anterior and severe posterior MAC were associated with increased mortality. MVA <1.5 cm2 predicted mortality in calcific mitral stenosis. On multivariable analysis, MVA remained associated with mortality (adjusted HR: 1.56; 95% CI: 1.03-2.38), independent of age and chronic kidney disease, both strong predictors of death. CONCLUSIONS The prognosis of MAC-related mitral stenosis was poor, with a 5-year survival of 57%, mainly driven by noncardiac mortality in calcific mitral stenosis. Severity of mitral stenosis was one of the independent predictors in this high-risk population.
Kato et al. (Sun,) conducted a cohort in Mitral annular calcification-related mitral stenosis (n=264). Mitral valve area was evaluated on All-cause mortality (adjusted HR 1.56, 95% CI 1.03-2.38). Mitral valve area was independently associated with all-cause mortality in patients with MAC-related mitral stenosis, who had an overall 5-year survival of 57% (adjusted HR 1.56; 95% CI 1.03-2.38).
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