Seo Jiwon, Jeong Hyeonju, Cho Iksung, Hong Geu-Ru, Ha Jong-Won, Shim Chi Young
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.
Division of Cardiology, Department of Internal Medicine, Myongji Hospital, Hanyang University Medical Center, Seoul, South Korea.
Front Cardiovasc Med. 2021 Oct 14;8:736040. doi: 10.3389/fcvm.2021.736040. eCollection 2021.
Heterogeneous mechanisms may contribute to the occurrence of mitral annular calcification (MAC), however, little is known about the sex differences in MAC and the clinical implications of these differences. This study aimed to investigate clinical and imaging differences of MAC according to sex. In total, 537 patients (221 men) with MAC were identified by transthoracic echocardiography at a single center from January 2012 to June 2016. Moderate-to-severe MAC was defined as calcification extent ≥120° of the mitral annulus. Significant functional mitral stenosis (MS) was defined as a transmitral mean diastolic pressure gradient ≥5 mmHg. Women more frequently had moderate-to-severe MAC and concomitant mitral regurgitation than men; however, significant functional MS was comparable between sexes. In the logistic regression analysis, old age, uncontrolled hypertension, end-stage renal disease (ESRD), and obstructive hypertrophic cardiomyopathy were significantly associated with moderate-to-severe MAC in women, whereas ESRD and moderate-to-severe aortic stenosis were in men. In the Cox regression analysis, significant functional MS was associated with all-cause death in both sexes, although an independent association was found in only women. Women had more extended MAC than men. Significant functional MS was independently associated with unfavorable clinical outcomes in patients with MAC, which was more pronounced in women than in men.
多种机制可能导致二尖瓣环钙化（MAC）的发生，然而，关于MAC的性别差异及其临床意义却知之甚少。本研究旨在探讨MAC在临床和影像学方面的性别差异。2012年1月至2016年6月期间，在一个中心通过经胸超声心动图共识别出537例MAC患者（221例男性）。中度至重度MAC定义为二尖瓣环钙化范围≥120°。显著功能性二尖瓣狭窄（MS）定义为二尖瓣平均舒张期压力阶差≥5 mmHg。女性比男性更易出现中度至重度MAC及合并二尖瓣反流；然而，两性之间显著功能性MS的发生率相当。在逻辑回归分析中，高龄、未控制的高血压、终末期肾病（ESRD）和梗阻性肥厚型心肌病与女性的中度至重度MAC显著相关，而男性则与ESRD和中度至重度主动脉瓣狭窄相关。在Cox回归分析中，显著功能性MS与两性的全因死亡均相关，不过仅在女性中发现存在独立关联。女性的MAC范围比男性更广。显著功能性MS与MAC患者不良临床结局独立相关，且在女性中比在男性中更为明显。
