AI Article Synopsis

  • The study explores how the severity of mitral annular calcification (MAC) impacts hemodynamic changes in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI).
  • A total of 708 patients were analyzed, revealing that those with increasing MAC severity experienced significant increases in mean transmitral gradient (mTMG) post-TAVI, while those without MAC showed no change.
  • The findings suggest that MAC severity should be considered when planning further mitral valve treatments if patients do not improve after TAVI, as MVA and stroke volume index (SVi) did not significantly change.

Article Abstract

Purposes: Predicting hemodynamic changes of stenotic mitral valve (MV) lesions with mitral annular calcification (MAC) following transcatheter aortic valve implantation (TAVI) may inform clinical decision-making. This study aimed to investigate the association between the MAC severity quantified by computed tomography (CT) and changes in mean transmitral gradient (mTMG), mitral valve area (MVA) and stroke volume index (SVi) following TAVI.

Methods And Results: A total of 708 patients (median age 81, 52% male) with severe aortic stenosis (AS) underwent pre-procedural CT and pre- and post-TAVI transthoracic echocardiography. According to the classification of MAC severity determined by CT, 299 (42.2%) patients had no MAC, 229 (32.3%) mild MAC, 102 (14.4%) moderate MAC, and 78 (11.0%) severe MAC. After adjusting for age and sex, there was no significant change in mTMG following TAVI (Δ mTMG = 0.07 mmHg, 95% CI -0.10 to 0.23, P = 0.92) for patients with no MAC. In contrast, patients with mild MAC (Δ mTMG = 0.21 mmHg, 95% CI 0.01 to 0.40, P = 0.018), moderate MAC (Δ mTMG = 0.31 mmHg, 95% CI 0.02 to 0.60, P = 0.019) and severe MAC (Δ mTMG = 0.43 mmHg, 95% CI 0.10 to 0.76, P = 0.0012) had significant increases in mTMG following TAVI, with greater changes associated with increasing MAC severity. In contrast, there was no significant change in MVA or SVi following TAVI.

Conclusion: In patients with severe AS undergoing TAVI, MAC severity was associated with greater increases in post-procedural mTMG whereas MVA or SVi remained unchanged. MAC severity should be considered for potential subsequent MV interventions if TAVI does not improve symptoms.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10673730PMC
http://dx.doi.org/10.1007/s10554-023-02931-wDOI Listing

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