Caseous mitral valve calcification and concurrent hypertrophic obstructive cardiomyopathy: A rare cause of stroke

Ullah, Waqas; Haas, Donald; Almas, Talal; Al-Mukhtar, Aws; Inayat, Asad

doi:10.1016/j.ijcha.2020.100647

Cited by 1 publication

(1 citation statement)

References 10 publications

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“…Structural abnormalities of the MV and its apparatus, such as elongated mitral leaflets and displacement and anomalous insertion of papillary muscle, cause SAM or MV prolapse and eventually MR. 6 , 7 , 8 In addition, MAC is often observed in patients with HCM and can be the cause of MV functional abnormalities, such as MS and MR. 17 , 18 , 19 , 20 In particular, several cases of extensive or progressive MAC have been reported in obstructive HCM, perhaps related to elevated peak LV systolic pressure and excess annular tension leading to subsequent annular degeneration. 20 , 21 , 22 In the present study, we investigated the prevalence of SAM, MV prolapse, and MAC as representative MV structural abnormalities that can be diagnosed through transthoracic echocardiogram and evaluated the prevalence and degree of MR and MS as MV functional abnormalities. In this study, the overall prevalence of SAM, MV prolapse, and MAC in collective HCM was 12.5%, 2.4%, and 13.0%, respectively.…”

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confidence: 99%

Prognostic Implication of Mitral Valve Disease and Its Progression in East Asian Patients With Hypertrophic Cardiomyopathy

Kim

Seo

Cho

et al. 2023

JAHA

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Background Hypertrophic cardiomyopathy (HCM) is a genetic disorder affecting not only the myocardium but also the mitral valve (MV) and its apparatus. This study aimed to investigate the prognostic implication of MV disease and its progression in East Asian patients with HCM. Methods and Results We assessed MV structure and function on the indexed echocardiogram of 1185 patients with HCM (mean±SD age, 60±14 years; men, 67%) in a longitudinal HCM registry, and 667 patients who performed follow‐up echocardiogram after 3 to 5 years were also analyzed. Progression of mitral regurgitation (MR) was defined as the increase of at least 1 grade. Clinical outcomes were defined as a composite of cardiovascular death, heart failure hospitalization, MV surgery or septal myectomy, and heart transplantation. Most of the entire cohort was nonobstructive type (n=1081 [91.2%]). A total of 278 patients (23.5%) showed at least mild MR on indexed echocardiogram. MR, systolic anterior motion, and mitral annular calcification were more prevalent in patients with obstructive HCM. During 7.0±4.0 years of follow‐up, presence of MR was independently associated with poor clinical outcomes (hazard ratio [HR], 1.60 [95% CI, 1.07–2.40]; P =0.023). On follow‐up echocardiogram, 67 (10.0%) patients showed MR progression, and it was independently associated with poor prognosis (HR, 2.46 [95% CI, 1.29–4.71]; P =0.007). Conclusions In East Asian patients with HCM whose major type is nonobstructive, MV disease is common. MR, systolic anterior motion, and mitral annular calcification are more prevalent in patients with obstructive HCM. The presence and progression of MR are associated with a poor prognosis in patients with HCM.

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