Introduction
Materials and methods
Study population
Cardiac computed tomography data acquisition and mitral annulus calcification assessment
Echocardiography
Statistical analysis
Results
Clinical and echocardiographic characteristics
Variable | Overall, N = 708 | No MAC, N = 299 | Mild MAC, N = 229 | Moderate MAC, N = 102 | Severe MAC, N = 78 | P-value |
---|---|---|---|---|---|---|
Age, years | 81 (76–85) | 81 (76–84) | 81 (76–85) | 82 (77–85) | 83 (78–86) | 0.25 |
Male sex, % | 371 (52%) | 172 (58%) | 131 (57%) | 49 (48%) | 19 (24%)*†§ | < 0.001 |
BMI (kg/m2) | 25.9 (23.7–28.7) | 25.7 (23.7–28.6) | 26.0 (24.1–29.0) | 26.0 (23.4–28.9) | 25.7 (23.5–28.6) | 0.69 |
Systolic blood pressure (mmHg) | 138 (121–150) | 136 (119–150) | 139 (122–150) | 140 (124–151) | 139 (125–154) | 0.22 |
Diastolic blood pressure (mmHg) | 67 (60–75) | 66 (60–75) | 65 (59–76) | 67 (60–74) | 69 (61–75) | 0.67 |
Hypertension, % | 527 (75%) | 222 (74%) | 176 (77%) | 72 (71%) | 57 (75%) | 0.69 |
Dyslipidemia, % | 451 (64%) | 192 (64%) | 145 (63%) | 66 (65%) | 48 (62%) | 0.98 |
Diabetes mellitus, % | 196 (28%) | 78 (26%) | 59 (26%) | 37 (36%) | 22 (28%) | 0.21 |
Previous stroke/TIA, % | 115 (19%) | 52 (21%) | 27 (14%) | 17 (20%) | 19 (30%)§ | 0.049 |
Coronary artery disease, % | 424 (60%) | 187 (63%) | 134 (59%) | 62 (61%) | 41 (53%) | 0.42 |
Atrial fibrillation, % | 161 (23%) | 62 (21%) | 64 (28%) | 15 (15%) | 20 (26%) | 0.039 |
COPD, % | 140 (21%) | 53 (19%) | 50 (23%) | 23 (24%) | 14 (18%) | 0.57 |
NYHA class III or IV, % | 388 (55%) | 158 (53%) | 131 (58%) | 57 (56%) | 42 (54%) | 0.77 |
Beta-blocker, % | 420 (59%) | 182 (61%) | 144 (63%) | 54 (53%) | 40 (51%) | 0.15 |
ACEi or ARB, % | 385 (54%) | 156 (52%) | 135 (59%) | 54 (53%) | 40 (51%) | 0.41 |
Diuretics, % | 388 (55%) | 152 (51%) | 134 (59%) | 57 (56%) | 45 (58%) | 0.32 |
Statin, % | 458 (65%) | 193 (65%) | 145 (63%) | 73 (72%) | 47 (60%) | 0.40 |
P2Y12 inhibitor, % | 237 (33%) | 101 (34%) | 78 (34%) | 35 (34%) | 23 (29%) | 0.89 |
Oral anticoagulation, % | 250 (36%) | 98 (33%) | 86 (38%) | 35 (34%) | 31 (41%) | 0.53 |
eGFR (mL/min/1.73m2) | 66 (50–83) | 67 (51–82) | 68 (51–86) | 63 (48–75) | 62 (48–77) | 0.18 |
Hemoglobin (mmol/L) | 7.80 (7.10–8.50) | 7.90 (7.20–8.60) | 7.85 (7.00–8.50) | 7.85 (6.90–8.40) | 7.55 (6.82–8.12)* | 0.005 |
Variable | Overall, N = 708 | No MAC, N = 299 | Mild MAC, N = 229 | Moderate MAC, N = 102 | Severe MAC, N = 78 | P-value |
---|---|---|---|---|---|---|
Heart rate, bpm | 69 (61–77) | 67 (60–76) | 68 (61–74) | 71 (63–78) | 70 (63–78) | 0.044 |
LV end-diastolic diameter index, mm/m2 | 24.9 (22.3–28.0) | 24.6 (22.5–28.1) | 25.0 (21.8–27.5) | 25.4 (22.1–28.5) | 24.8 (23.0–26.8) | 0.65 |
LV end-systolic diameter index, mm/m2 | 17.4 (14.1–20.7) | 17.6 (14.4–21.0) | 17.6 (14.5–20.9) | 17.1 (14.1–20.7) | 15.5 (12.6–18.5)*† | 0.008 |
LV mass index, g/m2 | 121 (99–145) | 117 (96–143) | 124 (102–149) | 126 (103–146) | 120 (101–145) | 0.31 |
LV end diastolic volume index, ml/m2 | 48 (38–61) | 50 (39–67) | 50 (40–62) | 48 (37–61) | 38 (30–46)*†§ | < 0.001 |
LV end systolic volume index, mm/m2 | 19 (13–31) | 20 (12–32) | 22 (14–34) | 19 (14–28) | 15 (11–21)*†§ | < 0.001 |
LV ejection fraction, % | 58 (48–65) | 59 (48–66) | 57 (46–64) | 58 (51–66) | 61 (53–67)† | 0.025 |
Left atrial volume index, ml/m2 | 40 (30–51) | 36 (27–46) | 41 (31–52)* | 42 (32–52)* | 48 (40–63)*†§ | < 0.001 |
Stroke volume index, ml/m2 | 38 (31–47) | 39 (32–48) | 38 (31–47) | 38 (32–45) | 39 (31–48) | 0.78 |
Aortic peak velocity, m/s | 3.97 (3.44–4.48) | 3.96 (3.43–4.41) | 3.95 (3.40–4.47) | 4.00 (3.47–4.38) | 4.15 (3.66–4.72) | 0.16 |
Aortic mean pressure gradient, mmHg | 41 (31–52) | 40 (31–51) | 40 (30–51) | 40 (29–51) | 44 (32–56) | 0.29 |
Aortic valve area, cm | 0.78 (0.63–0.94) | 0.78 (0.64–0.92) | 0.80 (0.63–0.95) | 0.77 (0.61–0.96) | 0.75 (0.62–0.92) | 0.82 |
Moderate or severe aortic regurgitation | 120 (17%) | 38 (13%) | 46 (20%) | 23 (23%) | 13 (17%) | 0.049 |
Mean mitral pressure gradient, mmHg | 2.08 (1.47–3.05) | 1.64 (1.23–2.29) | 2.10 (1.49–2.88)* | 2.95 (1.99–3.84)*† | 3.55 (2.53–5.24)*† | < 0.001 |
Mitral valve area, cm | 2.38 (1.88–2.99) | 2.71 (2.09–3.21) | 2.38 (1.94–2.88)* | 2.16 (1.73–2.68)*† | 1.81 (1.48–2.28)*†§ | < 0.001 |
Moderate or severe mitral regurgitation | 141 (20%) | 57 (19%) | 49 (21%) | 17 (17%) | 18 (23%) | 0.67 |
Mitral inflow E wave velocity, cm/s | 85 (64–109) | 71 (55–92) | 88 (69–109)* | 95 (70–118)* | 121 (97–141)*†§ | < 0.001 |
Mitral inflow E/A ratio | 0.77 (0.60–1.13) | 0.72 (0.58–1.04) | 0.80 (0.60–1.16) | 0.72 (0.58–0.99) | 0.93 (0.71–1.22)*§ | 0.001 |
Tricuspid regurgitation maximal velocity, m/s | 2.62 (2.32–3.00) | 2.60 (2.29–3.00) | 2.67 (2.39–3.02) | 2.63 (2.29–2.92) | 2.62 (2.38–2.98) | 0.48 |
Association between MAC severity and changes in mitral valve hemodynamics following TAVI
Severity of MAC | Pre-TAVI mean TMG (95% CI)* | Post-TAVI mean TMG (95% CI)* | Δ mean TMG (95% CI) | P-value† |
---|---|---|---|---|
No MAC | 1.90 (1.74 to 2.05) | 1.97 (1.81 to 2.12) | 0.07 (-0.10 to 0.23) | 0.92 |
Mild MAC | 2.40 (2.22 to 2.58) | 2.61 (2.43 to 2.79) | 0.21 (0.01 to 0.40) | 0.018 |
Moderate MAC | 3.06 (2.79 to 3.32) | 3.36 (3.10 to 3.63) | 0.31 (0.02 to 0.60) | 0.019 |
Severe MAC | 4.11 (3.80 to 4.42) | 4.54 (4.23 to 4.85) | 0.43 (0.10 to 0.76) | 0.0012 |