title: Concomitant mitral annular calcification and severe aortic stenosis: prevalence, characteristics and outcome following transcatheter aortic valve replacement.
abstract: OBJECTIVE
  Calcified aortic stenosis (AS) and mitral annular calcification (MAC) have certain similar etiology and pathophysiological mechanisms. MAC is frequently encountered in pre-procedural computed tomography (CT) imaging of patients that undergo transcatheter aortic valve replacement (TAVR), but its prognostic implications for these patients have not been thoroughly investigated. This study sought to evaluate the prevalence of MAC among patients with severe AS and to assess the clinical implications of MAC on these patients during and following TAVR.
  
  
  RESULTS
  Consecutive patients that underwent TAVR were compared according to the existence of MAC and its severity in pre-TAVR CT scans. From the entire cohort of 761 patients, 49.3% had MAC, and 50.7% did not have MAC. Mild MAC was present in 231 patients (30.4%), moderate MAC in 72 patients (9.5%), and severe MAC in 72 patients (9.5%). Thirty-day mortality and major complications were similar between patients with and without MAC. In a multivariable survival analysis, severe MAC was found to be an independent strong predictor of overall mortality following TAVR (all-cause mortality: hazards ratio [HR] 1.95, 95% confidence interval [CI] 1.24-3.07, P = 0.004; cardiovascular mortality: HR 2.35, 95% CI 1.19-4.66; P = 0.01). Severe MAC was also found to be an independent strong predictor of new permanent pacemaker implantation (PPI) after TAVR (OR 2.83, 95% CI 1.08-7.47; P = 0.03).
  
  
  CONCLUSIONS
  Half of the patients with severe AS evaluated for TAVR were found to have MAC. Severe MAC is associated with increased all-cause and cardiovascular mortality and with conduction abnormalities following TAVR and should be included in future risk stratification models for TAVR.
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Yigal
authors.initials: Y
authors.lastname: Abramowitz
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Kazuno
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Tarun
authors.initials: T
authors.lastname: Chakravarty
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kawamori
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Maeno
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Anderson
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Zev
authors.initials: Z
authors.lastname: Allison
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Geeteshwar
authors.initials: G
authors.lastname: Mangat
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Wen
authors.initials: W
authors.lastname: Cheng
authors.affiliation: Advanced Cardiovascular Imaging, the Heart Hospital Baylor Plano (Baylor Scott and White Healthcare System), Plano, TX, USA.
authors.forename: Ambarish
authors.initials: A
authors.lastname: Gopal
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Hasan
authors.initials: H
authors.lastname: Jilaihawi
authors.affiliation: Department of Cardiovascular Surgery, the Heart Hospital Baylor Plano (Baylor Scott and White Healthcare System), Plano, TX, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mack
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Raj R
authors.initials: RR
authors.lastname: Makkar
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000401:mortality / Q000601:surgery; D002114:Calcinosis / Q000150:complications / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000401:mortality / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000150:complications / Q000401:mortality / Q000601:surgery
keywords: Mitral annulus calcification; TAVI; TAVR; Transcatheter aortic valve implantation