scholarly journals A Cardiac Computed Tomography–Based Score to Categorize Mitral Annular Calcification Severity and Predict Valve Embolization

2020 ◽  
Vol 13 (9) ◽  
pp. 1945-1957 ◽  
Author(s):  
Mayra Guerrero ◽  
Dee Dee Wang ◽  
Amit Pursnani ◽  
Mackram Eleid ◽  
Omar Khalique ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cardiac Computed Tomography ◽  
Mitral Annular Calcification ◽  
Annular Calcification

Mitral annular calcification and valvular dysfunction: multimodality imaging evaluation, grading, and management

2021 ◽  
Author(s):  
Bo Xu ◽  
Duygu Kocyigit ◽  
Tom Kai Ming Wang ◽  
Carmela D Tan ◽  
E Rene Rodriguez ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Classification System ◽  
Multimodality Imaging ◽  
Imaging Modality ◽  
Cardiac Computed Tomography ◽  
Calcium Deposition ◽  
Mitral Annular Calcification ◽  
Imaging Evaluation ◽  
Line Imaging ◽  
Annular Calcification

Abstract Mitral annular calcification (MAC) refers to calcium deposition in the fibrous skeleton of the mitral valve. It has many cardiovascular associations, including mitral valve dysfunction, elevated cardiovascular risk, arrhythmias, and endocarditis. Echocardiography conventionally is the first-line imaging modality for anatomic assessment, and evaluation of mitral valve function. Cardiac computed tomography (CT) has demonstrated importance as an imaging modality for the evaluation and planning of related procedures. It also holds promise in quantitative grading of MAC. Currently, there is no universally accepted definition or classification system of MAC severity. We review the multimodality imaging evaluation of MAC and associated valvular dysfunction and propose a novel classification system based on qualitative and quantitative measurements derived from echocardiography and cardiac CT.

Predictors of Left Ventricular Outflow Tract Obstruction After Transcatheter Mitral Valve Replacement in Severe Mitral Annular Calcification: An Analysis of the Transcatheter Mitral Valve Replacement in Mitral Annular Calcification Global Registry

2021 ◽  
Vol 14 (10) ◽  
Author(s):  
Abdallah El Sabbagh ◽  
Mohammed Al-Hijji ◽  
Dee Dee Wang ◽  
Mackram Eleid ◽  
Marina Urena ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Multidetector Row Computed Tomography ◽  
Mitral Annular Calcification ◽  
Transcatheter Mitral Valve Replacement ◽  
Annular Calcification

Background: Several studies have evaluated preprocedural imaging predictors of left ventricular outflow tract obstruction (LVOTO) after transcatheter mitral valve replacement. The patient cohorts in these studies were heterogeneous and included patients with transcatheter mitral valve replacement in failed bioprostheses, annuloplasty rings, and severe mitral annular calcification (MAC). The goal of this study was to evaluate predictors of LVOTO specific to patients undergoing valve-in-MAC. Methods: This study included patients with severe MAC who underwent valve-in-MAC and had optimal quality preprocedural multidetector row computed tomography scans eligible for retrospective analysis. Baseline demographic, echocardiographic, and procedural data on these patients were collected. multidetector row computed tomography parameters were analyzed for association with LVOTO, defined as increase in mean LVOT gradient by ≥10 mm Hg with accompanying hemodynamic instability. Results: Seventy-one patients with optimal preprocedural computed tomography scans were included in this study (mean age, 72.5±13.5 years), 9 of which developed LVOTO (all female). Baseline mean LVOT area, neo-LVOT area (145.3 versus 270.9 mm 2 ; P =0.006), indexed neo-LVOT area (90.1 versus 157.4; P =0.05), and virtual transcatheter heart valve to septum distance (3.1 versus 6.9 mm; P =0.002) were lower in the LVOTO group. Expected % LVOT area reduction was higher in the latter group (58.3 versus 42.7%; P =0.008). In the univariable analysis, the baseline mean LVOT area, neo-LVOT area, indexed neo-LVOT area, and valve to septum distance were all significantly associated with LVOTO. Conclusions: The systolic mean LVOT area, neo-LVOT area, indexed neo-LVOT, expected percentage LVOT area reduction, and the valve to septum distance were associated with LVOTO after valve-in-MAC.

scholarly journals Purposeful use of multimodality imaging in the diagnosis of caseous mitral annular calcification: a case series report

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Krunoslav Michael Sveric ◽  
Ivan Platzek ◽  
Elena Golgor ◽  
Ralf-Thorsten Hoffmann ◽  
Axel Linke ◽  
...  
Keyword(s):  
Multimodality Imaging ◽  
Cardiac Computed Tomography ◽  
Case Series ◽  
Rare Condition ◽  
Definitive Diagnosis ◽  
Mitral Annular Calcification ◽  
Typical Structure ◽  
Benign Condition ◽  
Outer Capsule ◽  
Annular Calcification

Abstract Background Caseous mitral annular calcification (CMAC) is a rare liquefactive variant of mitral annular calcification (MAC) and superficially mimics a cardiac vegetation or abscess. CMAC is viewed as a benign condition of MAC, while MAC has clinical implications for patients’ lives. Correctly diagnosing CMAC is essential in order to avoid unnecessary interventions, cardiac surgery or even psychological suffering for the patient. Case presentation We report on 6 patients with suspected intra-cardiac masses of the mitral annulus that were referred to our institution for further clarification. A definitive diagnosis of CMAC was achieved by combining echocardiography (Echo), cardiac magnetic resonance imaging (MRI) and cardiac computed tomography (CT) for these patients. Echo assessed the mass itself and possible interactions with the mitral valve. MRI was useful in differentiating the tissue from other benign or malign neoplasms. CT revealed the typical structure of CMAC with a “soft” liquefied centre and an outer capsule with calcification. Conclusion CMAC is a rare condition, and most clinicians and even radiologists are not familiar with it. CMAC can be mistaken for an intra-cardiac tumour, thombus, vegetation, or abscess. Non-invasive multimodality imaging (i.e. Echo, MRI, and CT) helps to establish a definitive diagnosis of CMAC and avoid unnecessary interventions especially in uncertain cases.

Abstract 17000: Quantifying Mitral Annular Calcification Using Echocardiography: Comparison to MAC Calcium Score From Gated Computed Tomography

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
William Harvey ◽  
Sheldon Litwin
Keyword(s):  
Computed Tomography ◽  
Mitral Valve ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Calcium Score ◽  
Mitral Annulus ◽  
Atrial Volume ◽  
Mitral Annular Calcification ◽  
Close Proximity ◽  
Annular Calcification

Introduction: Mitral Annular Calcification (MAC) is present in 25-40% of people ≥ 60 years old and has associations with atrial fibrillation, stroke, endocarditis, mitral regurgitation, and mitral stenosis. MAC poses major challenges to surgical or transcatheter mitral valve interventions. Current echocardiographic methods for assessing MAC are limited. Goals: To assess transthoracic echocardiographic (TTE) approaches for quantifying MAC severity compared to a gold standard of MAC calcium score by gated computed tomography (CT). Methods: 75 patients undergoing evaluation for TAVR had TTE and CT in close proximity. MAC area and circumference were measured in parasternal long-axis (PLAX), parasternal short-axis (PSAX), and apical 2, 3, and 4-chamber views on TTE. Mitral valve gradients and left atrial volume were recorded. The curvilinear length of MAC in the PSAX view on TTE and cardiac CT were also measured. Associations between various TTE measures and MAC calcium score were assessed using linear regression. Results: Median age was 75.3, 50.4% female, 85.3% Caucasian. MAC area and circumference in PSAX on TTE showed moderate correlations (R 2 =0.32-0.37) with MAC calcium score. Curvilinear MAC length measures on SAX TTE and CT had improved correlation with MAC score (R 2 =0.41 & 0.78, Figure). Combined circumference of MAC from PLAX+PSAX had the strongest association (R 2 = 0.48). Interobserver variability on CT and TTE had coefficients of variation ranging 17-37%. Left atrial volume and mitral valve gradients had weak associations with MAC severity (R 2 =0.03-0.12). Tertiles of MAC calcium scores were 2650, 5150 and 7750. Conclusions: MAC length in the PSAX view showed the strongest association with MAC severity. Dedicated PSAX views of the mitral annulus may improve the ability to reproducibly grade MAC severity by echo.

Abstract 14823: Comparison of a Novel Computed Tomography-Based Assessment of Mitral Annular Calcification to Transthoracic Echocardiogram

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jakob Park ◽  
Angela Y Higgins ◽  
Yekaterina Kim ◽  
Bradley Kay ◽  
Kamil Faridi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Calcium Score ◽  
High Sensitivity ◽  
Derived Categories ◽  
Mitral Annular Calcification ◽  
High Tertile ◽  
Visual Rating ◽  
Ct Data ◽  
Contrast Ct ◽  
Annular Calcification

Introduction: Mitral annular calcification (MAC) is associated with increased stroke and death. The typical assessment by transthoracic echocardiography (TTE) is qualitative visual rating (VR), but this technique is user-dependent and lacks a gold standard for grading. Computed tomography (CT) has high sensitivity for calcium and can quantify MAC. The purpose of this study is to standardize grading of MAC and compare TTE-based assessment of MAC with CT. Methods: The analysis included 60 patients with non-contrast CT and TTE prior to aortic valve replacement or mitral valve (MV) repair. MAC was assessed on TTE by VR (none, mild, moderate, severe), a previously described echo calcium score (ECS), and systematic MAC grading (SMAC). TTE-based MV parameters were recorded. CT data were measured for calcium volume (MACV) via proprietary software (Visage Imaging) by an independent rater with 3D regions of interest in the MV area. Results: Mean age was 77 ± 11; 42% of patients were female. MACV for tertile-based groups (lowest, middle, highest) are shown in the Table. CT detected MAC in a notable portion of patients without MAC by TTE-derived methods: in 16 of 29 patients (55%) by VR, in 5 out of 15 (33%) by ECS, and in 5 out of 16 (31%) by SMAC. Fifteen of 22 patients (68%) with mild MAC by VR had middle or high-tertile MAC on CT. MACV-derived categories reclassified 65%, 60%, and 54% of patients compared with VR, ECS, and SMAC grading by TTE, respectively. Differences were also found across MACV categories for MV velocity, transmitral gradient, and E/e’. Except E/e’, trends were independent of TTE-based MAC analysis and significant after adjusting for mitral regurgitation or stenosis. Conclusions: TTE has limited ability to detect mild MAC compared with CT. This novel CT-based volumetric MAC assessment is feasible and can improve standardized quantification and sensitivity to detect MAC at lower values. Higher MACV by CT was associated with increasingly abnormal MV flow and diastology.

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