Key result
Quantitative MAC scoring using the Agatston method demonstrated excellent inter-reader agreement (ICC 0.998) and high accuracy for diagnosing mitral stenosis (AUC 0.84).
Why the study?
The reliability of subjective and objective quantification of mitral annular calcification in elderly patients with severe aortic stenosis, its reference values, and its correlation with mitral valve disease were not established.
Does quantitative evaluation of mitral annular calcification using the Agatston score provide better reliability than subjective categorization in elderly patients with severe aortic stenosis?
Observational (n=559)
Does quantitative evaluation of mitral annular calcification using the Agatston score provide better reliability than subjective categorization in elderly patients with severe aortic stenosis?
Effect estimate: ICC 0.998
Quantitative MAC scoring may enhance reliability versus subjective assessment in severe AS; leaves open whether it improves risk stratification or outcomes.
Purpose To determine the reliability of subjective and objective quantification of mitral annular calcification (MAC) in elderly patients with severe aortic stenosis, to define quantitative sex- and age-related reference values of MAC, and to correlate quantitative MAC with mitral valve disease. Methods In this retrospective, IRB-approved study, we included 559 patients (268 females, median age 81 years, inter-quartile range 77–85 years) with severe aortic stenosis undergoing CT. Four independent readers performed subjective MAC categorization as follows: no, mild, moderate, and severe MAC. Two independent readers performed quantitative evaluation of MAC using the Agatston score method (Agatston MAC ). Mitral valve disease was determined by echocardiography. Results Subjective MAC categorization showed high inter-reader agreement for no (k = 0.88) and severe MAC (k = 0.75), whereas agreement for moderate (k = 0.59) and mild (k = 0.45) MAC was moderate. Intra-reader agreement for subjective MAC categorization was substantial (k = 0.69 and 0.62). Inter- and intra-reader agreement for Agatston MAC were excellent (ICC = 0.998 and 0.999, respectively), with minor inconsistencies in MAC involving the left ventricular outflow tract/aortic valve. There were significantly more women than men with MAC (n = 227, 85% versus n = 209, 72%; p < 0.001), with a significantly higher Agatston MAC (median 597, range 81–2055 versus median 244; range 0–1565; p < 0.001), particularly in patients ≥85 years of age. Agatston MAC showed an area-under-the-curve of 0.84 to diagnose mitral stenosis, whereas there was no association of Agatston MAC with mitral regurgitation (p > 0.05). Conclusions Our study in elderly patients with severe aortic stenosis shows that quantitative MAC scoring is more reliable than subjective MAC assessment. Women show higher Agatston MAC scores than men, particularly in the elderly population. Agatston MAC shows high accuracy to diagnose mitral stenosis.
No takes yet. Share an insight, caveat, or question.
Eberhard et al. (2020) conducted an observational in severe aortic stenosis (n=559). Quantitative evaluation of MAC using the Agatston score method vs. Subjective MAC categorization was evaluated on Inter-reader agreement for Agatston MAC (ICC 0.998). Quantitative MAC scoring using the Agatston method demonstrated excellent inter-reader agreement (ICC 0.998) and high accuracy for diagnosing mitral stenosis (AUC 0.84).
Synapse has enriched 3 closely related papers on similar clinical questions. Consider them for comparative context: