Key result
Increased relative wall thickness is linked to ~28.8-fold higher odds of mitral annular calcification.
Why the study?
The multifactorial pathogenesis of mitral annular calcification remains poorly understood. In particular, the association between sex-specific differences in LV response to pressure overload and MAC had not been thoroughly investigated.
Does concentric left ventricular geometry and mechanical load on the mitral valve associate with the presence and severity of mitral annular calcification in individuals aged 60-75 years from the general population?
Cross-Sectional (n=463)
Does concentric left ventricular geometry and mechanical load on the mitral valve associate with the presence and severity of mitral annular calcification in individuals aged 60-75 years from the general population?
Concentric left ventricular geometry (specifically relative wall thickness) and mechanical stress on the mitral valve are strongly associated with the presence and severity of mitral annular calcification in the general population, helping explain why severe calcification disproportionately affects women.
LV geometry and mitral stress associate with MAC beyond comorbidities; leaves open causality and utility for risk stratification in older adults.
Aims - Mitral annular calcification (MAC) is common in the general population, especially among women and patients with left ventricular (LV) pressure overload conditions, which may increase stress onto the mitral valve inducing the calcification process. The pathogenesis of MAC is presumed multifactorial, but remains poorly understood. Women display a different LV response to pressure overload compared to men, but this association has rather not been thoroughly investigated. Methods and results - The DANCAVAS pilot study included 1422 randomly selected individuals from the general population aged 60-75 years to undergo a computed tomography (CT)-based screening program. After the exclusion of patients due to prior mitral valve surgery (n=2) and patients with missing echocardiographic data (n=957), 463 individuals were included in this substudy. They were stratified according to MAC severity based on mitral valve calcification (MVC) score assessed by CT. MAC was found in 165 (32.6%) patients with MVC scores <100 AU in 20.7%, 100-400 AU in 8.2% and >400 AU in 6.7%. While MAC was most prevalent in men, women presented with higher MVC scores and severe MAC on echocardiography. Patients with MAC were elderly with cardiovascular risk factors. Concentric LV geometry with smaller LV cavities and higher relative wall thickness assessed by echocardiography were highly associated with MAC (p<0.001). From multivariate analyses, relative wall thickness and the mechanical load on the mitral valve (i.e. StressMV = (systolic blood pressure + aortic mean gradient)/(π x [LV end-systolic diameter/2]2)) strongly associated with MAC (standard deviation-adjusted OR 28.8, 95% CI [15.6;53.5] and 2.97 [2.25;3.91], respectively) and MAC severity (10.9 [7.74;15.5] and 2.98 [2.33;3.82], respectively). The predictive performance was high with area under curve (AUC) of 0.78 [0.74;0.82] by including StressMV in the model of age, sex and cardiovascular comorbidity (p<0.001). However, relative wall thickness had distinctive importance (AUC 0.96 [0.94;0.98], p<0.001) regardless of sex. Conclusion - MAC is common in the general population with the highest prevalence among men. LV geometry and the pressure on the mitral valve are crucial factors in the pathogenesis of MAC, and sex-specific differences in LV response to pressure overload may elucidate why more extensive grades of MAC mainly affect women.
No takes yet. Share an insight, caveat, or question.
Engelsgaard et al. (2026) conducted a cross-sectional in Mitral annular calcification (MAC) (n=463). Left ventricular relative wall thickness and mitral valve mechanical load (StressMV) was evaluated on Presence of mitral annular calcification (MAC) (OR 28.8, 95% CI 15.6-53.5, p=<0.001). Relative wall thickness (OR 28.8; 95% CI 15.6-53.5) and mitral valve mechanical stress (OR 2.97; 95% CI 2.25-3.91) were strongly associated with mitral annular calcification.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: