Background: Various risk factors are known to be associated with development of mitral annular calcification (MAC). However, little is known about risk factors that are associated with its progression. In this study, we aimed to identify clinical and echocardiographic risk factors for progression.
Methods: We searched our echocardiogram database for patients who had MAC from year 1996-2013. MAC was reported in a semi-quantitative, visual manner by at least experienced echocardiographers at our institution for each study. Patients were included in the study population if they had MAC at their index study and underwent more than two studies in the period of two years or more. Patients with prior mitral valve surgery, rheumatic heart disease, or other identifiable mitral disease were excluded from the study.
Results: A total of 2927 patients (18487 studies) met the criteria and was included in the study. Mean age of our study population was 71 ± 11 years and the mean follow up time was 4.8 ± 2.8 years. Average number of echocardiograms per patient was 8 ± 5. Age >= 65, male sex, EF < 50%, CKD stage >= 4, atrial fibrillation (AF), leaflet prolapse, warfarin use and left ventricular hypertrophy (LVH) were identified using a univariate model using a p value cutoff of < 0.1. Multivariate modeling revealed risk factors for progression were age >= 65, CKD stage 5, and LVH.
Conclusion: There were similarities and differences with risk factors for MAC development and MAC progression. Warfarin and AF were not associated with progression, whereas advanced age, female sex, advanced CKD and LVH were associated with MAC progression. Male sex, preserved EF and leaflet prolapse appeared to be favorable factors for MAC progression.