Hemodynamic implications of mitral annular calcification in patients undergoing transcatheter aortic valve implantation for severe aortic stenosis

Int J Cardiovasc Imaging. 2023 Nov;39(11):2183-2192. doi: 10.1007/s10554-023-02931-w. Epub 2023 Oct 6.

Abstract

Purposes: Predicting hemodynamic changes of stenotic mitral valve (MV) lesions with mitral annular calcification (MAC) following transcatheter aortic valve implantation (TAVI) may inform clinical decision-making. This study aimed to investigate the association between the MAC severity quantified by computed tomography (CT) and changes in mean transmitral gradient (mTMG), mitral valve area (MVA) and stroke volume index (SVi) following TAVI.

Methods and results: A total of 708 patients (median age 81, 52% male) with severe aortic stenosis (AS) underwent pre-procedural CT and pre- and post-TAVI transthoracic echocardiography. According to the classification of MAC severity determined by CT, 299 (42.2%) patients had no MAC, 229 (32.3%) mild MAC, 102 (14.4%) moderate MAC, and 78 (11.0%) severe MAC. After adjusting for age and sex, there was no significant change in mTMG following TAVI (Δ mTMG = 0.07 mmHg, 95% CI -0.10 to 0.23, P = 0.92) for patients with no MAC. In contrast, patients with mild MAC (Δ mTMG = 0.21 mmHg, 95% CI 0.01 to 0.40, P = 0.018), moderate MAC (Δ mTMG = 0.31 mmHg, 95% CI 0.02 to 0.60, P = 0.019) and severe MAC (Δ mTMG = 0.43 mmHg, 95% CI 0.10 to 0.76, P = 0.0012) had significant increases in mTMG following TAVI, with greater changes associated with increasing MAC severity. In contrast, there was no significant change in MVA or SVi following TAVI.

Conclusion: In patients with severe AS undergoing TAVI, MAC severity was associated with greater increases in post-procedural mTMG whereas MVA or SVi remained unchanged. MAC severity should be considered for potential subsequent MV interventions if TAVI does not improve symptoms.

Keywords: Aortic stenosis; Hemodynamics; Mitral annular calcification; Mitral stenosis; Transcatheter aortic valve intervention.

MeSH terms

  • Aged, 80 and over
  • Aortic Valve / diagnostic imaging
  • Aortic Valve / pathology
  • Aortic Valve / surgery
  • Aortic Valve Stenosis* / complications
  • Aortic Valve Stenosis* / diagnostic imaging
  • Aortic Valve Stenosis* / surgery
  • Calcinosis* / complications
  • Calcinosis* / diagnostic imaging
  • Calcinosis* / surgery
  • Female
  • Hemodynamics
  • Humans
  • Male
  • Mitral Valve / diagnostic imaging
  • Mitral Valve / surgery
  • Mitral Valve Stenosis* / complications
  • Mitral Valve Stenosis* / diagnostic imaging
  • Mitral Valve Stenosis* / surgery
  • Predictive Value of Tests
  • Severity of Illness Index
  • Transcatheter Aortic Valve Replacement* / adverse effects
  • Treatment Outcome