Echocardiography Laboratory, St Bartholomew's Hospital, London, UK.
William Harvey Institute, Queen Mary University of London, London, UK.
Echocardiography. 2020 Oct;37(10):1543-1550. doi: 10.1111/echo.14846. Epub 2020 Sep 10.
Mitral annular calcification (MAC) is a chronic degenerative process affecting the annular fibrosus of the mitral valve. We sought to examine the relationship between MAC and the progression of valve disease.
The echocardiography database was searched for patients with MAC who had undergone at least two studies more than 1 year apart. The degree of MAC was quantified according to both extent and thickness. The degree of aortic stenosis (AS) and mitral stenosis (MS) was classified according to valve area and mean gradient, respectively.
Of 125 patients, moderate or greater AS was present in 8 of 86 (9.3%) patients with mild, 12 of 29 (41.4%) patients with moderate, and 4 of 10 (40%) patients with severe MAC extent, P = .0002. The rate of progression of AS was highest in those with greatest MAC extent (0.21 cm /y) or greatest MAC thickness (0.28 cm /y) compared with those with least MAC extent (0.09 cm /y) or thickness (0.07 cm /y), P = .04 and <.0001, respectively. The rate of progression of mean mitral gradient was highest in those with greatest MAC extent (0.71 mm Hg/y) or greatest MAC thickness (0.17 mm Hg/y) compared with those with least MAC extent (0.07 mm Hg/y) or thickness (0.07 mm Hg/y), P = .0003 and P < .0001, respectively. Patients with greatest MAC extent had lower survival than those with lower MAC extent, P = .03. However, there was no difference in survival between patients with different MAC thickness, P = .43.
Both the degree of MAC extent and thickness are associated with the rate of progression of aortic and mitral stenosis and may serve as a risk marker for future progression.
二尖瓣环钙化（MAC）是一种影响二尖瓣环形纤维的慢性退行性病变。我们试图研究 MAC 与瓣膜病进展之间的关系。
在超声心动图数据库中搜索至少两次检查相隔 1 年以上且存在 MAC 的患者。根据 MAC 的程度和厚度来量化 MAC 的程度。主动脉瓣狭窄（AS）和二尖瓣狭窄（MS）的程度分别根据瓣口面积和平均梯度进行分类。
在 125 例患者中，轻度 MAC 患者中有 8 例（9.3%）、中度 MAC 患者中有 12 例（41.4%）和重度 MAC 患者中有 4 例（40%）存在中度或更严重的 AS，P = 0.0002。MAC 程度最大（0.21cm/y）或厚度最大（0.28cm/y）的患者 AS 进展率最高，而 MAC 程度最小（0.09cm/y）或厚度最小（0.07cm/y）的患者进展率最低，P = 0.04 和<.0001。MAC 程度最大（0.71mmHg/y）或厚度最大（0.17mmHg/y）的患者平均二尖瓣梯度进展率最高，而 MAC 程度最小（0.07mmHg/y）或厚度最小（0.07mmHg/y）的患者进展率最低，P = 0.0003 和 P<.0001。MAC 程度最大的患者生存率低于 MAC 程度较低的患者，P = 0.03。然而，MAC 厚度不同的患者生存率无差异，P = 0.43。
MAC 程度和厚度均与主动脉瓣和二尖瓣狭窄的进展速度相关，可能是未来进展的风险标志物。
