Mayra Guerrero1, Dee Dee Wang2, Amit Pursnani3, Mackram Eleid4, Omar Khalique5, Marina Urena6, Michael Salinger3, Susheel Kodali5, Tatiana Kaptzan7, Bradley Lewis8, Nahoko Kato4, Hector M Cajigas9, Olaf Wendler10, David Holzhey11, Ashish Pershad12, Christian Witzke13, Sami Alnasser14, Gilbert H L Tang15, Kendra Grubb16, Mark Reisman17, Philipp Blanke18, Jonathon Leipsic18, Eric Williamson19, Patricia A Pellikka4, Sorin Pislaru4, Juan Crestanello20, Dominique Himbert6, Alec Vahanian21, John Webb17, Rebecca T Hahn5, Martin Leon5, Isaac George22, Vinayak Bapat22, William O'Neill2, Charanjit Rihal4. 1. Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, Minnesota. Electronic address: guerrero.mayra@mayo.edu. 2. Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan. 3. Division of Cardiology, NorthShore University HealthSystem, Evanston, Illinois. 4. Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, Minnesota. 5. Division of Cardiology, Columbia University Medical Center, New York, New York. 6. Department of Cardiology, Bichat Hospital, Paris, France. 7. Cardiovascular Research Unit, Mayo Clinic Hospital, Rochester, Minnesota. 8. Department of Health Sciences Research, Mayo Clinic Hospital, Rochester, Minnesota. 9. University of Illinois College of Medicine, Chicago, Illinois. 10. Department of Surgery, King's College Hospital, London, United Kingdom. 11. Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany. 12. Division of Cardiology, Banner University Medical Center, Phoenix, Arizona. 13. Division of Cardiology, Einstein Medical Center, Philadelphia, Pennsylvania. 14. Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada; Northern Ontario School of Medicine, Health Sciences North, Sudbury, Ontario. 15. Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York. 16. Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia. 17. Division of Cardiology, University of Washington Medical Center, Seattle, Washington. 18. Center for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. 19. Department of Radiology, Mayo Clinic Hospital, Rochester, Minnesota. 20. Department of Cardiac Surgery, Mayo Clinic Hospital, Rochester, Minnesota. 21. Universite de Paris, Paris, France. 22. Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York.
Abstract
OBJECTIVES: This study aims to establish a computed tomography (CT)-based scoring system for grading mitral annular calcification (MAC) severity and potentially aid in predicting valve embolization during transcatheter mitral valve (MV) replacement using balloon-expandable aortic transcatheter heart valves. BACKGROUND: Transcatheter MV replacement is emerging as an alternative treatment for patients with severe MAC who are not surgical candidates. Although cardiac CT is the imaging modality of choice in the evaluation of candidates for valve-in-MAC (ViMAC), a standardized grading system to quantify MAC severity has not been established. METHODS: We performed a multicenter retrospective review of cardiac CT and clinical outcomes of patients undergoing ViMAC. A CT-based MAC score was created using the following features: average calcium thickness (mm), degrees of annulus circumference involved, calcification at one or both fibrous trigones, and calcification of one or both leaflets. Features were assigned points according to severity (total maximum score = 10) and severity grade was assigned based on total points (mild ≤3, moderate 4 to 6, and severe ≥7 points). The association between MAC score and device migration/embolization was evaluated. RESULTS: Of 117 patients in the TMVR in MAC registry, 87 had baseline cardiac CT of adequate quality. Of these, 15 were treated with transatrial access and were not included. The total cohort included 72 (trans-septal = 37, transapical = 35). Mean patient age was 74 ± 12 years, 66.7% were female, and the mean Society of Thoracic Surgery risk score was 15.4 ± 10.5%. The mean MAC score was 7.7 ± 1.4. Embolization/migration rates were lower in higher scores: Patients with a MAC score of 7 had valve embolization/migration rate of 12.5%, MAC score ≥8 had a rate of 8.7%, and a MAC score of ≥9 had zero (p = 0.023). Patients with a MAC score of ≤6 had 60% embolization/migration rate versus 9.7% in patients with a MAC score ≥7 (p < 0.001). In multivariable analysis, a MAC score ≤6 was in independent predictor of valve embolization/migration (odds ratio [OR]: 5.86 [95% CI: 1.00 to 34.26]; p = 0.049). CONCLUSIONS: This cardiac CT-based score provides a systematic method to grade MAC severity which may assist in predicting valve embolization/migration during trans-septal or transapical ViMAC procedures.
OBJECTIVES: This study aims to establish a computed tomography (CT)-based scoring system for grading mitral annular calcification (MAC) severity and potentially aid in predicting valve embolization during transcatheter mitral valve (MV) replacement using balloon-expandable aortic transcatheter heart valves. BACKGROUND: Transcatheter MV replacement is emerging as an alternative treatment for patients with severe MAC who are not surgical candidates. Although cardiac CT is the imaging modality of choice in the evaluation of candidates for valve-in-MAC (ViMAC), a standardized grading system to quantify MAC severity has not been established. METHODS: We performed a multicenter retrospective review of cardiac CT and clinical outcomes of patients undergoing ViMAC. A CT-based MAC score was created using the following features: average calcium thickness (mm), degrees of annulus circumference involved, calcification at one or both fibrous trigones, and calcification of one or both leaflets. Features were assigned points according to severity (total maximum score = 10) and severity grade was assigned based on total points (mild ≤3, moderate 4 to 6, and severe ≥7 points). The association between MAC score and device migration/embolization was evaluated. RESULTS: Of 117 patients in the TMVR in MAC registry, 87 had baseline cardiac CT of adequate quality. Of these, 15 were treated with transatrial access and were not included. The total cohort included 72 (trans-septal = 37, transapical = 35). Mean patient age was 74 ± 12 years, 66.7% were female, and the mean Society of Thoracic Surgery risk score was 15.4 ± 10.5%. The mean MAC score was 7.7 ± 1.4. Embolization/migration rates were lower in higher scores: Patients with a MAC score of 7 had valve embolization/migration rate of 12.5%, MAC score ≥8 had a rate of 8.7%, and a MAC score of ≥9 had zero (p = 0.023). Patients with a MAC score of ≤6 had 60% embolization/migration rate versus 9.7% in patients with a MAC score ≥7 (p < 0.001). In multivariable analysis, a MAC score ≤6 was in independent predictor of valve embolization/migration (odds ratio [OR]: 5.86 [95% CI: 1.00 to 34.26]; p = 0.049). CONCLUSIONS: This cardiac CT-based score provides a systematic method to grade MAC severity which may assist in predicting valve embolization/migration during trans-septal or transapical ViMAC procedures.
Authors: Matti Adam; Elmar Kuhn; Hendrik Wienemann; Victor Mauri; Laurin Ochs; Maria Isabel Körber; Kaveh Eghbalzadeh; Christos Iliadis; Marcel Halbach; Thorsten Wahlers; Stephan Baldus Journal: Clin Res Cardiol Date: 2022-09-15 Impact factor: 6.138
Authors: Pedro Covas; Haneen Ismail; Joseph Krepp; Brian G Choi; Jannet F Lewis; Richard J Katz; Andrew D Choi Journal: Curr Treat Options Cardiovasc Med Date: 2021-03-15
Authors: Jonathan R Weir-McCall; Kelley Branch; Maros Ferencik; Ron Blankstein; Andrew D Choi; Brian B Ghoshhajra; Kavitha Chinnaiyan; Purvi Parwani; Edward Nicol; Koen Nieman Journal: J Cardiovasc Comput Tomogr Date: 2020-10-01
Authors: Manuel Barreiro-Perez; Berenice Caneiro-Queija; Luis Puga; Rocío Gonzalez-Ferreiro; Robert Alarcon; Jose Antonio Parada; Andrés Iñiguez-Romo; Rodrigo Estevez-Loureiro Journal: J Clin Med Date: 2021-12-20 Impact factor: 4.241