Impact of Mitral Annular Calcification Burden on Cardiovascular Outcomes in Aortic Stenosis Patients Undergoing Valve Replacement: A CCT-Based Quantification Study

Mitral annulus calcification (MAC) is a chronic, complex, and highly prevalent process involving the mitral valve's base. In recent decades, the pathophysiological aspects of MAC have evolved significantly and now is recognized as a complex disease rather than merely a benign, age-related degenerative process. Emerging evidence highlights a substantial link between mitral annular calcification (MAC) and calcific aortic stenosis (AS). This correlation is not coincidental and should not surprise, as both conditions share common pathophysiological mechanisms, including chronic inflammation, atherosclerosis, and increased mechanical stress. Emerging research suggests that the presence of MAC is independently associated with an elevated risk of cardiovascular events in patients with severe mitral valve diseases and transcatheter mitral valve replacement. However, the prognostic significance of MAC in patients with AS undergoing aortic valve replacement (AVR) remains unclear due to limited and inconsistent findings. Cardiac computed tomography (CCT) is essential for pre-procedural planning in transcatheter aortic valve replacement (TAVR), and allows the assessment of cardiovascular calcification, including MAC burden, providing a holistic and comprehensive evaluation of its severity. However, the prognostic implications of MAC burden, assessed using the latest validated CCT methods, have not been comprehensively investigated in patients with AS undergoing AVR. Therefore, our objective was to investigate the impact of MAC burden on cardiovascular outcomes in patients with AS undergoing AVR, utilizing the recently validated CCT quantification method for a more precise assessment of MAC severity.