Relationships between mitral annular calcification and cardiovascular events: A meta‐analysis

Wang, Tom Kai Ming; Griffin, Brian P.; Xu, Bo; Rodriguez, L. Leonardo; Popović, Zoran B.; Gillinov, Marc; Pettersson, Gösta; Desai, Milind Y.

doi:10.1111/echo.14861

Cited by 14 publications

(8 citation statements)

References 52 publications

(113 reference statements)

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“…Therefore, we focused on the association between progressive calcification and left valvular disease. Several meta-analyses have indicated an association between AVC and MVC and worse outcomes in the general population with or without CVD 27 – 30 . While AVC and MVC share similar contributing factors, such as aging, abnormal calcium and phosphate metabolism, and systemic atherosclerosis 31 , previous studies have reported differences in the underlying mechanisms.…”

Section: Discussionmentioning

confidence: 99%

The association of peritoneal dialysis and hemodialysis on mitral and aortic valve calcification associated mortality: a meta-analysis

Chiu,

Chen,

et al. 2024

Sci Rep

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Cardiac valve calcification (CVC), characterized by the accumulation of calcium in the heart valves, is highly prevalent among patients undergoing dialysis. This meta-analysis aimed to provide an updated summary of recent studies on the prognostic value of CVC in patients undergoing dialysis. We conducted a search of PubMed, Embase, and Web of Science to identify observational studies investigating cardiovascular or all-cause mortality associated with CVC in dialysis patients until March 2023. Hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) were calculated for the meta-analysis, and the strength and significance of the associations between CVC and mortality outcomes in dialysis patients were assessed. From 6218 initially identified studies, we included 10 critical studies with a total of 3376 dialysis patients in a further meta-analysis. Pooled analyses demonstrated a significant association between CVC and an elevated risk of all-cause and cardiovascular mortality in dialysis patients. In our study, we discovered HRs of 1.592 (95% CI 1.410–1.797) for all-cause mortality and 2.444 (95% CI 1.632–3.659) for cardiovascular mortality. Furthermore, subgroup analysis revealed elevated all-cause mortality among patients with mitral valve calcification (HR 1.572; 95% CI 1.200–2.060) compared to those with aortic valve calcification (HR 1.456; 95% CI 1.105–1.917). Similarly, patients undergoing peritoneal dialysis faced a greater risk for all-cause mortality (HR 2.094; 95% CI 1.374–3.191) than those on hemodialysis (HR 1.553; 95% CI 1.369–1.763). This highlights the possibility of CVC being an independent risk factor for dialysis patients, particularly in relation to mitral valve calcification or peritoneal dialysis.

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Section: Discussionmentioning

confidence: 99%

The association of peritoneal dialysis and hemodialysis on mitral and aortic valve calcification associated mortality: a meta-analysis

Chiu,

Chen,

et al. 2024

Sci Rep

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“…Our findings are consistent with a recent meta‐analysis where the presence MAC was an independent predictor of mortality and major adverse cardiovascular events. 22 …”

Section: Discussionmentioning

confidence: 99%

Feasibility and Outcomes of Mitral Transcatheter Edge‐To‐Edge Repair in Patients With Variable Degrees of Mitral Annular Calcification

Hatab,

Bou Chaaya,

Zaid

et al. 2023

JAHA

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Background The clinical significance of mitral annular calcification (MAC) in patients undergoing mitral transcatheter edge‐to‐edge repair is not well understood. There is limited evidence regarding the feasibility, durability of repair, and the prognostic value of MAC in this population. We sought to examine the prognostic value of MAC, its severity, and its impact on procedural success and durability of mitral transcatheter edge‐to‐edge repair. Methods and Results We reviewed the records of 280 patients with moderate–severe or severe mitral regurgitation who underwent mitral transcatheter edge‐to‐edge repair with MitraClip from March 2014 to March 2022. The primary end point was cumulative survival at 1 year. Independent factors associated with the primary end point were identified using multivariable Cox regression. Among 280 patients included in the final analysis, 249 had none/mild MAC, and 31 had moderate/severe MAC. Median follow‐up was 23.1 months (interquartile range: 11.1–40.4). Procedural success was comparable in the MAC and non‐MAC groups (92.6% versus 91.4%, P =0.79) with similar rates of residual mitral regurgitation ≤2 at 1 year (86.7% versus 93.2%, P =0.55). Moderate/severe MAC was associated with less improvement in New York Heart Association III/IV at 30 days when compared with none/mild MAC (45.8% versus 14.3%, P =0.001). The moderate/severe MAC group had lower cumulative 1‐year survival (56.8% versus 80.0%, hazard ratio [HR], 1.98 [95% CI, 1.27–3.10], P =0.002). Moderate/severe MAC and Society of Thoracic Surgeons predicted risk of mortality for mitral valve repair were independently associated with the primary end point (HR, 2.20 [1.10–4.41], P =0.02; and HR, 1.014 [1.006–1.078], P =0.02, respectively). Conclusions Mitral TEER is a safe and feasible intervention in selected patients with significant MAC and associated with similar mitral regurgitation reduction at 1 year compared with patients with none/mild MAC. Patients with moderate/severe MAC had a high 1‐year mortality and less improvement in their symptoms after TEER.

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“…58 Although not as well studied as CAVD, the clinical associations between increased mitral annular calcification and worsening cardiovascular morbidity and mortality are evident. 59 In a study of 204 CKD patients stages 2 and 3, >30% of the study participants had detectable aortic or mitral valve calcification, 60 and other studies have observed even higher rates of aortic valve abnormalities. 20 Declining renal function accelerates mineral deposition in these tissues, with severe valvular dysfunction observed in patients significantly younger than the general population.…”

Section: Calcification Of the Cardiac Valvesmentioning

confidence: 95%

“… 58 Although not as well studied as CAVD, the clinical associations between increased mitral annular calcification and worsening cardiovascular morbidity and mortality are evident. 59 …”

Section: Heterogeneity Of Cardiovascular Calcification and Its Clinic...mentioning

confidence: 99%

Cardiovascular Calcification Heterogeneity in Chronic Kidney Disease

Hutcheson

Goettsch

2023

Circulation Research

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Patients with chronic kidney disease (CKD) exhibit tremendously elevated risk for cardiovascular disease, particularly ischemic heart disease, due to premature vascular and cardiac aging and accelerated ectopic calcification. The presence of cardiovascular calcification associates with increased risk in patients with CKD. Disturbed mineral homeostasis and diverse comorbidities in these patients drive increased systemic cardiovascular calcification in different manifestations with diverse clinical consequences, like plaque instability, vessel stiffening, and aortic stenosis. This review outlines the heterogeneity in calcification patterning, including mineral type and location and potential implications on clinical outcomes. The advent of therapeutics currently in clinical trials may reduce CKD-associated morbidity. Development of therapeutics for cardiovascular calcification begins with the premise that less mineral is better. While restoring diseased tissues to a noncalcified homeostasis remains the ultimate goal, in some cases, calcific mineral may play a protective role, such as in atherosclerotic plaques. Therefore, developing treatments for ectopic calcification may require a nuanced approach that considers individual patient risk factors. Here, we discuss the most common cardiac and vascular calcification pathologies observed in CKD, how mineral in these tissues affects function, and the potential outcomes and considerations for therapeutic strategies that seek to disrupt the nucleation and growth of mineral. Finally, we discuss future patient-specific considerations for treating cardiac and vascular calcification in patients with CKD—a population in need of anticalcification therapies.

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Relationships between mitral annular calcification and cardiovascular events: A meta‐analysis

Cited by 14 publications

References 52 publications

The association of peritoneal dialysis and hemodialysis on mitral and aortic valve calcification associated mortality: a meta-analysis

The association of peritoneal dialysis and hemodialysis on mitral and aortic valve calcification associated mortality: a meta-analysis

Feasibility and Outcomes of Mitral Transcatheter Edge‐To‐Edge Repair in Patients With Variable Degrees of Mitral Annular Calcification

Cardiovascular Calcification Heterogeneity in Chronic Kidney Disease

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