Mitral annular calcification in patients with hypertrophic obstructive cardiomyopathy: risk factors and prognosis

Abstract

Objective This research aimed to ascertain the risk factors for the development of mitral annular calcification (MAC) in patients with hypertrophic obstructive cardiomyopathy (HOCM) and the impact of MAC on prognosis. Methods HOCM patients underwent interventricular diaphragmatic myectomy were collected and examined by echocardiography and CT to test whether MAC occurred or not. General data and risk factors affecting MAC development in HOCM patients were observed. Differences in cardiac function indicators and perioperative clinical data were compared between patients with MAC and those without MAC. After surgery, patients were followed up until December 2022, with the primary endpoint being postoperative all-cause mortality and the secondary endpoint being major adverse cardiovascular and cerebrovascular events (MACCE). Prognosis and MACCE occurrence were analyzed, and differences in brain natriuretic peptide (BNP), Apelin, and Galectin-3 levels were assessed between patients with MAC and patients without MAC, and the correlation between factor levels and cardiac function indicators were explored. Results There were 24 patients with MAC (7.74%) and 286 patients without MAC (92.26%). Female and older patients were more common in the MAC group. The MAC group had a higher incidence of SAM sign, aortic annular calcification, aortic calcification, coronary artery calcification, mitral leaflet thickening, and moderate and severe tricuspid regurgitation. Gender, age, aortic calcification, aortic annular calcification, SAM sign, and mitral leaflet thickening were independent risk factors for MAC development. The MAC group had higher LVEDD, lower LVEF and heavier LVMM than the no-MAC group. Patients in the no-MAC group had a better prognosis and better MACCE incidence than patients in the MAC group. Conclusion Independent risk factors affecting MAC development in HOCM patients are gender, age, aortic calcification, aortic annular calcification, SAM sign, and mitral leaflet thickening. MAC development may lead to a poor prognosis in HOCM patients.