Key result
MAC with mitral valve dysfunction is linked to higher 2-year mortality, reaching ~26% with ≥moderate MR.
Why the study?
The authors sought to describe the natural history of patients with mitral annular calcification with and without mitral valve dysfunction.
Does the presence of mitral annular calcification and mitral valve dysfunction increase all-cause mortality compared to patients without MAC?
Observational (n=15,372)
Does the presence of mitral annular calcification and mitral valve dysfunction increase all-cause mortality compared to patients without MAC?
p-value: p=<.001
Mitral annular calcification, particularly when accompanied by mitral valve dysfunction, is associated with significantly increased 2-year mortality, yet interventions remain infrequently performed.
MAC with mitral dysfunction signals high mortality risk; leaves open whether intervention improves survival in this observational cohort.
Background Mitral annular calcification (MAC) is a chronic and progressive degenerative process characterized by calcium and lipid deposition of the mitral valve annulus. We sought to describe the natural history of patients with MAC with and without mitral valve dysfunction (MVD). Methods We conducted an observational study of patients with an echocardiogram-based diagnosis of MAC from 2006-2023. Patients were matched by age and sex in a 1:1 ratio to patients without MAC. We collected baseline clinical, echocardiographic, and computed tomography data. The primary end point was all-cause mortality. We also report predictors of mortality in patients with MAC and MVD. Results We included 15,372 patients in the analysis: 7686 with MAC (median age, 76 years [68-84], 58% women) and 7686 without MAC matched by age and sex. Patients with MAC had higher rates of comorbidities, cardiovascular risk factors, MVD, and multivalvular heart disease (aortic stenosis/regurgitation and tricuspid regurgitation) relative to patients without MAC (all P < .001). Two-year mortality was 14%, 26%, and 21% for patients with MAC and no MVD, MAC with ≥moderate MR, and MAC with ≥moderate MS, respectively ( P < .001). Surgical or transcatheter mitral valve interventions in patients with MAC and significant MVD were infrequently performed (n = 136/788, 17.2%). Conclusions Ten percent of patients with MAC have clinically significant MVD, with mitral regurgitation being more common than mitral stenosis. The presence of MVD is associated with significantly increased mortality in patients with MAC.
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Méndez-Hirata et al. (2025) conducted an observational in Mitral annular calcification (n=15,372). Mitral annular calcification vs. Patients without mitral annular calcification was evaluated on all-cause mortality (p=<.001). Mitral annular calcification with concurrent mitral valve dysfunction is associated with significantly increased 2-year mortality, reaching 26% in those with ≥moderate mitral regurgitation (P<.001).
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