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Eberhard M. Assessment of the mitral valve with cardiac CT may improve preoperative stratification of patients with rheumatic heart disease. Eur Radiol 2024:10.1007/s00330-024-10597-8. [PMID: 38273089 DOI: 10.1007/s00330-024-10597-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 01/27/2024]
Affiliation(s)
- Matthias Eberhard
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
- Radiology, Spitäler fmi AG, Unterseen, Switzerland.
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2
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Hou J, Sun Y, Wang H, Zhang L, Shi J, You H, Zhang R, Yang B. Noncontrast cardiac computed tomography-derived mitral annular calcification scores in mitral valve disease. Clin Cardiol 2023; 46:1310-1318. [PMID: 37501607 PMCID: PMC10642324 DOI: 10.1002/clc.24110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND AND AIMS Mitral annular calcification (MAC) by computed tomography (CT) is reported as an independent predictor of poor outcomes. However, it currently remains unclear if quantitative MAC parameters provide more value for mitral valve disease (MVD) management, therefore, we examined the prognostic value of MAC scores using noncontrast cardiac-CT in MVD patients. METHODS Between January 2020 and December 2021, we prospectively enrolled 300 consecutive patients with MVD (MAC-present = 80 and MAC-absent = 220) undergoing preoperative cardiac-CT and mitral valve (MV) surgery. Noncontrast cardiac-CT images were used to qualitatively detect MAC (present or absent) and evaluate MAC scores. For analyses, we also collected baseline clinical data, intraoperative conversion (from MV repair to MV replacement), and follow-up arrhythmia data. RESULTS Compared with the MAC-absent group, MAC-present patients were older (62 ± 7 vs. 58 ± 9 years, p < .001), mostly women (55% vs. 39.5%, p = .017), and also had aortic valve calcification (57.5% vs. 23.2%, p < .001), mitral stenosis (82.5% vs. 61.8%, p < .001), atrial fibrillation (30% vs. 11.8%, p < .001), and larger left atrial end-diastolic dimension (LADD, 49 [44-56] versus 46 [41-50], p = .001]. Furthermore, MAC-present patients underwent more MV replacements (61.8% vs. 82.5%, p = .001) and experienced a higher intraoperative conversion prevalence (11.8% vs. 61.3%, p < .001). Multiple logistic regression analyses showed that the female gender (odds ratio [OR]/95% confidence interval [CI]/p = 2.001/1.042-3.841/0.037) and MAC scores (OR/95% CI/p = 10.153/4.434-23.253/p < .001) were independent predictors of intraoperative conversion. During a follow-up of 263 ± 134 days, MAC-present patients had more arrhythmias (42.5% vs. 9.5%, p < .001). Also, MAC-scores (hazard ratio [HR]/95% CI/p = 6.841/3.322-14.089/p < .001) and LADD (HR/95% CI/p = 1.039/1.018-1.060/p < .001) were independently associated with arrhythmias by Cox regression analyses. CONCLUSIONS Noncontrast cardiac CT-derived MAC-scores showed a high risk for intraoperative conversion and follow-up arrhythmias in MVD-patients.
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Affiliation(s)
- Jie Hou
- College of Medicine and Biological Information EngineeringNortheastern UniversityShenyangLiaoningChina
- Department of RadiologyGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
- Key Laboratory of Cardiovascular Imaging and Research of Liaoning ProvinceShenyangLiaoningChina
| | - Yu Sun
- College of Medicine and Biological Information EngineeringNortheastern UniversityShenyangLiaoningChina
- Department of RadiologyGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
- Key Laboratory of Cardiovascular Imaging and Research of Liaoning ProvinceShenyangLiaoningChina
| | - Huishan Wang
- Department of Cardiovascular SurgeryGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
| | - Libo Zhang
- Department of RadiologyGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
- Key Laboratory of Cardiovascular Imaging and Research of Liaoning ProvinceShenyangLiaoningChina
| | - Jinglong Shi
- Department of RadiologyGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
- Key Laboratory of Cardiovascular Imaging and Research of Liaoning ProvinceShenyangLiaoningChina
| | - Hongrui You
- Department of RadiologyGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
- Key Laboratory of Cardiovascular Imaging and Research of Liaoning ProvinceShenyangLiaoningChina
| | - Rongrong Zhang
- Department of RadiologyGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
- Key Laboratory of Cardiovascular Imaging and Research of Liaoning ProvinceShenyangLiaoningChina
| | - Benqiang Yang
- Department of RadiologyGeneral Hospital of Northern Theater CommandShenyangLiaoningChina
- Key Laboratory of Cardiovascular Imaging and Research of Liaoning ProvinceShenyangLiaoningChina
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3
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Hirasawa K, Butcher SC, Pereira AR, Meucci MC, Stassen J, van Rosendael P, Marsan NA, Bax JJ, Delgado V. Hemodynamic implications of mitral annular calcification in patients undergoing transcatheter aortic valve implantation for severe aortic stenosis. Int J Cardiovasc Imaging 2023; 39:2183-2192. [PMID: 37798420 PMCID: PMC10673730 DOI: 10.1007/s10554-023-02931-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 08/08/2023] [Indexed: 10/07/2023]
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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Affiliation(s)
- Kensuke Hirasawa
- Department of Cardiology, Leiden University Medical Center, Leiden, 2300RC, The Netherlands
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Steele C Butcher
- Department of Cardiology, Leiden University Medical Center, Leiden, 2300RC, The Netherlands
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia
| | - Ana Rita Pereira
- Department of Cardiology, Leiden University Medical Center, Leiden, 2300RC, The Netherlands
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | - Maria Chiara Meucci
- Department of Cardiology, Leiden University Medical Center, Leiden, 2300RC, The Netherlands
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Jan Stassen
- Department of Cardiology, Leiden University Medical Center, Leiden, 2300RC, The Netherlands
| | - Philippe van Rosendael
- Department of Cardiology, Leiden University Medical Center, Leiden, 2300RC, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, 2300RC, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, 2300RC, The Netherlands
- Heart Center, University of Turku, Turku University Hospital, Turku, Finland
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, 2300RC, The Netherlands.
- Department of Cardiology, Heart Lung Center, Albinusdreef 2, Leiden, 2300 RC, the Netherlands.
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Morariu PC, Tanase DM, Iov DE, Sîrbu O, Oancea AF, Mircea CG, Chiriac CP, Baroi GL, Morariu ID, Dascălu CG, Şorodoc L, Floria M. Mitral Annular Calcification and Thromboembolic Risk. Life (Basel) 2023; 13:1568. [PMID: 37511943 PMCID: PMC10381637 DOI: 10.3390/life13071568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/24/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
Thromboembolic (TE) risk scores used for atrial fibrillation (AF) patients do not include mitral annular calcification (MAC) as a potential indicator of vascular disease. This research evaluated the correlation between MAC and TE risk scores (CHADS2 and CHA2DS2-VASc). We compared TE risk score values and clinical and echocardiographic data in patients with and without MAC. We included, prospectively, 103 patients: 40.8% with AF, 83.5% with hypertension, 30.1% with type II diabetes mellitus, 79.6% with chronic heart failure, and 7.8% with a history of stroke. We identified MAC in 50.5% of patients. The mean CHADS2 and CHA2DS2-VASc scores were 2.56 ± 1.135 and 4.57 ± 1.61, respectively. In MAC patients, both scores tended to increase significantly compared with the control (2.88 ± 1.114 versus 2.24 ± 1.06, p = 0.005, and 5.21 ± 1.51 versus 3.92 ± 1.46, p < 0.001, respectively). The left ventricular ejection fraction negatively correlated with the presence of MAC (r = -0.254, p = 0.01). The presence of MAC was a risk factor for vascular disease (OR = 2.47, χ2 = 34.32, p < 0001). Conclusions: The presence of MAC is associated with greater TE risk scores and a higher risk of vascular disease. It appears that adding MAC as a vascular disease parameter to TE risk scores may have benefits for patients by improving their predictive value.
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Affiliation(s)
- Paula Cristina Morariu
- Department of Internal Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
- Medical Clinic, "Sf. Spiridon" Emergency Hospital, 700111 Iasi, Romania
| | - Daniela Maria Tanase
- Department of Internal Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
- Medical Clinic, "Sf. Spiridon" Emergency Hospital, 700111 Iasi, Romania
| | - Diana Elena Iov
- Department of Internal Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
- Medical Clinic, "Sf. Spiridon" Emergency Hospital, 700111 Iasi, Romania
| | - Oana Sîrbu
- Department of Internal Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
- Medical Clinic, "Sf. Spiridon" Emergency Hospital, 700111 Iasi, Romania
| | - Alexandru Florinel Oancea
- Department of Internal Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
- Cardiology Clinic, "Sf. Spiridon" Emergency Hospital Iași, 700111 Iasi, Romania
| | - Cornel Gabriel Mircea
- Department of Internal Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
| | | | - Genoveva Livia Baroi
- Department of Internal Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
- Surgery Clinic, "Sf. Spiridon" Emergency Hospital Iași, 700111 Iasi, Romania
| | - Ionela-Daniela Morariu
- Department of Environmental and Food Chemistry, "Grigore T. Popa" University of Medicine and Pharmacy Iași, 700111 Iasi, Romania
| | - Cristina Gena Dascălu
- Department of Medical Informatics and Biostatistics, Faculty of Dental Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
| | - Laurenţiu Şorodoc
- Department of Internal Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
- Medical Clinic, "Sf. Spiridon" Emergency Hospital, 700111 Iasi, Romania
| | - Mariana Floria
- Department of Internal Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 University Street, 700115 Iasi, Romania
- Medical Clinic, "Sf. Spiridon" Emergency Hospital, 700111 Iasi, Romania
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5
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Kolossváry M, Reid AB, Baggiano A, Nagpal P, Canan A, Al'Aref SJ, Andreini D, Cavalcante JL, de Cecco CN, Chelliah A, Chen MY, Choi AD, Dey D, Fairbairn T, Ferencik M, Gransar H, Hecht H, Leipsic J, Lu MT, Marwan M, Maurovich-Horvat P, Ng MY, Nicol ED, Pontone G, Vliegenthart R, Whelton SP, Williams MC, Arbab-Zadeh A, Farooqi KM, Weir-McCall J, Feuchtner G, Villines TC. The Journal of cardiovascular computed tomography: A year in review 2021. J Cardiovasc Comput Tomogr 2022; 16:266-276. [PMID: 35370125 DOI: 10.1016/j.jcct.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This review aims to summarize original articles published in the Journal of Cardiovascular Computed Tomography (JCCT) for the year 2021, focusing on those that had the most scientific and educational impact. The JCCT continues to expand; the number of submissions, published manuscripts, cited articles, article downloads, social media presence, and impact factor continues to increase. The articles selected by the Editorial Board of the JCCT in this review focus on coronary artery disease, coronary physiology, structural heart disease, and technical advances in cardiovascular CT. In addition, we highlight key consensus documents and guidelines published in the Journal in 2021. The Journal recognizes the tremendous work done by each author and reviewer this year - thank you.
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Affiliation(s)
- Márton Kolossváry
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anna B Reid
- University of Manchester NHS Foundation Trust, Manchester, UK
| | | | - Prashant Nagpal
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Arzu Canan
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Subhi J Al'Aref
- Department of Medicine, Division of Cardiology. University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA
| | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - João L Cavalcante
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Carlo N de Cecco
- Department of Radiology and Imaging Sciences, Division of Cardiothoracic Imaging, Emory University, Atlanta, GA, USA
| | - Anjali Chelliah
- Department of Pediatrics, Division of Cardiology, Goryeb Children's Hospital/Atlantic Health System, Morristown, NJ, USA; Department of Pediatrics, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Marcus Y Chen
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrew D Choi
- The George Washington University School of Medicine, Washington, DC, USA
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Timothy Fairbairn
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Heidi Gransar
- Department of Imaging, Cardiac Imaging Research, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Harvey Hecht
- Ican School of Medicine at Mount Sinai, Mount Sinai Morningside Medical Center, NYC, USA
| | - Jonathan Leipsic
- Department of Radiology and Medicine (Cardiology), University of British Columbia, Canada
| | - Michael T Lu
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mohamed Marwan
- Department of Cardiology, Friedrich-Alexander-Universität, Erlangen-Nürnberg, Germany
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Hungary; Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong SAR, China
| | - Edward D Nicol
- Departments of Cardiology and Radiology, Royal Brompton Hospital, London UK; School of Bioengineering and Imaging Sciences, Kings College, London, UK
| | | | - Rozemarijn Vliegenthart
- Department of Radiology, University of Groningen/University Medical Center Groningen, Groningen, the Netherlands
| | - Seamus P Whelton
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | | | - Armin Arbab-Zadeh
- Department of Medicine/Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Kanwal M Farooqi
- Department of Pediatrics, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Gudrun Feuchtner
- Innsbruck Medical University, Dept. Radiology, Innsbruck, Austria
| | - Todd C Villines
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA.
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6
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Renker M, Fischer-Rasokat U, Walther C, Kim WK, Rixe J, Dörr O, Nef H, Rolf A, Möllmann H, Hamm CW. Evaluation of Patients for Percutaneous Edge-to-edge Mitral Valve Repair: Comparison of Cardiac Computed Tomography Angiography With Transesophageal Echocardiography. J Thorac Imaging 2022; 37:187-193. [PMID: 34232143 DOI: 10.1097/rti.0000000000000602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We sought to compare parameters derived from cardiac computed tomography angiography (CCTA) with those from transesophageal echocardiography (TEE) for the evaluation of patients with severe mitral regurgitation (MR) before percutaneous edge-to-edge mitral valve repair (PE2E). TEE is the mainstay for PE2E, although it has specific limitations. CCTA enables measurements in any arbitrary plane with high spatial resolution and offers good calcium visibility. MATERIALS AND METHODS Patients who underwent TEE and CCTA before scheduled PE2E at 2 medical centers were included in this retrospective analysis. Quantitative parameters relevant for PE2E were obtained from TEE and CCTA in a blinded manner and the intrareviewer variability was assessed. RESULTS All 30 patients (15 female, 76±10 y) had secondary MR attributable to ischemic (60%) or nonischemic cardiomyopathy (40%). On comparing parameters from TEE and CCTA, left ventricular end-diastolic diameter was 60±11 versus 64±11 mm (r=0.90), intercommissural mitral annulus was 35±5 versus 35±5 mm (r=0.88), long-axis annulus was 33±5 versus 33±5 mm (r=0.74), the distance between the fossa ovalis and the leaflet coaptation was 42±5 versus 41±5 mm (r=0.81), the anterior mitral leaflet was 21±6 versus 20±7 mm (r=0.81), the posterior mitral leaflet was 13±2 versus 13±2 mm (r=0.91), and the median mitral calcification was 1 (interquartile range: 0 to 2) versus 0 (interquartile range: 0 to 1; r=0.53), respectively. Intrareviewer agreement was good and excellent for continuous and categorical variables, respectively. CONCLUSIONS Our data suggest that evaluation of the mitral valve apparatus with CCTA in patients considered for PE2E is feasible, correlates well with TEE, and offers improved calcium visibility. In selected cases, additional information from CCTA may be helpful for achieving optimal interventional results.
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Affiliation(s)
- Matthias Renker
- Department of Cardiology, Campus Kerckhoff of Justus-Liebig-University Giessen, Bad Nauheim
- German Center for Cardiovascular Research (DZHK), Partner Site Rhein-Main
| | - Ulrich Fischer-Rasokat
- Department of Cardiology, Campus Kerckhoff of Justus-Liebig-University Giessen, Bad Nauheim
- German Center for Cardiovascular Research (DZHK), Partner Site Rhein-Main
| | - Claudia Walther
- Department of Cardiology, Campus Kerckhoff of Justus-Liebig-University Giessen, Bad Nauheim
- German Center for Cardiovascular Research (DZHK), Partner Site Rhein-Main
- Department of Cardiology, University Hospital Frankfurt/Main, Frankfurt/Main
| | - Won-Keun Kim
- Department of Cardiology, Campus Kerckhoff of Justus-Liebig-University Giessen, Bad Nauheim
- German Center for Cardiovascular Research (DZHK), Partner Site Rhein-Main
| | - Johannes Rixe
- Department of Cardiology and Angiology, University Hospital of Giessen and Marburg, Giessen
| | - Oliver Dörr
- Department of Cardiology and Angiology, University Hospital of Giessen and Marburg, Giessen
| | - Holger Nef
- Department of Cardiology and Angiology, University Hospital of Giessen and Marburg, Giessen
| | - Andreas Rolf
- Department of Cardiology, Campus Kerckhoff of Justus-Liebig-University Giessen, Bad Nauheim
- German Center for Cardiovascular Research (DZHK), Partner Site Rhein-Main
| | - Helge Möllmann
- Department of Cardiology, Campus Kerckhoff of Justus-Liebig-University Giessen, Bad Nauheim
- German Center for Cardiovascular Research (DZHK), Partner Site Rhein-Main
- Department of Internal Medicine I, St.-Johannes-Hospital, Dortmund, Germany
| | - Christian W Hamm
- Department of Cardiology, Campus Kerckhoff of Justus-Liebig-University Giessen, Bad Nauheim
- German Center for Cardiovascular Research (DZHK), Partner Site Rhein-Main
- Department of Cardiology and Angiology, University Hospital of Giessen and Marburg, Giessen
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7
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Kipourou K, O’Driscoll JM, Sharma R. Valvular Heart Disease in Patients with Chronic Kidney Disease. Eur Cardiol 2022; 17:e02. [PMID: 35154392 PMCID: PMC8819604 DOI: 10.15420/ecr.2021.25] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/19/2021] [Indexed: 11/06/2022] Open
Abstract
Valvular heart disease (VHD) is highly prevalent in patients with chronic kidney disease (CKD) from the early stages to end-stage renal disease (ESRD). Aortic and mitral valves are the most frequently affected, leading to aortic valve and/or mitral annular calcification, which, in turn, causes either valve stenosis or regurgitation at an accelerated rate compared with the general population. Tricuspid regurgitation is also prevalent in CKD and ESRD, and haemodialysis patients are at an increasingly high risk of infective endocarditis. As for pathophysiology, several mechanisms causing VHD in CKD have been proposed, highlighting the complexity of the process. Echocardiography constitutes the gold standard for the assessment of VHD in CKD/ESRD patients, despite the progress of other imaging modalities. With regard to treatment, the existing 2017 European Society of Cardiology/European Association for Cardio-Thoracic Surgery guidelines on the management of VHD addressing patients with normal kidney function are also applied to patients with CKD/ESRD.
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Affiliation(s)
- Konstantina Kipourou
- Department of Cardiology, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Jamie M O’Driscoll
- Department of Cardiology, St George’s University Hospitals NHS Foundation Trust, London, UK; School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, UK
| | - Rajan Sharma
- Department of Cardiology, St George’s University Hospitals NHS Foundation Trust, London, UK; School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, UK
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8
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Xu B, Kocyigit D, Wang TKM, Tan CD, Rodriguez ER, Pettersson GB, Unai S, Griffin BP. Mitral annular calcification and valvular dysfunction: multimodality imaging evaluation, grading, and management. Eur Heart J Cardiovasc Imaging 2021; 23:e111-e122. [PMID: 34591959 DOI: 10.1093/ehjci/jeab185] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/02/2021] [Indexed: 11/12/2022] Open
Abstract
Mitral annular calcification (MAC) refers to calcium deposition in the fibrous skeleton of the mitral valve. It has many cardiovascular associations, including mitral valve dysfunction, elevated cardiovascular risk, arrhythmias, and endocarditis. Echocardiography conventionally is the first-line imaging modality for anatomic assessment, and evaluation of mitral valve function. Cardiac computed tomography (CT) has demonstrated importance as an imaging modality for the evaluation and planning of related procedures. It also holds promise in quantitative grading of MAC. Currently, there is no universally accepted definition or classification system of MAC severity. We review the multimodality imaging evaluation of MAC and associated valvular dysfunction and propose a novel classification system based on qualitative and quantitative measurements derived from echocardiography and cardiac CT.
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Affiliation(s)
- Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH 44195, USA
| | - Duygu Kocyigit
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH 44195, USA
| | - Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH 44195, USA
| | - Carmela D Tan
- Department of Cardiovascular Anatomical Pathology, Cleveland Clinic, Cleveland, OH 44195, USA
| | - E Rene Rodriguez
- Department of Cardiovascular Anatomical Pathology, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Brian P Griffin
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH 44195, USA
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9
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Birudaraju D, Cherukuri L, Pranesh S, Budoff MJ. Current methods to assess mitral annular calcification and its risk factors. Expert Rev Cardiovasc Ther 2021; 19:787-800. [PMID: 34348555 DOI: 10.1080/14779072.2021.1964361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Mitral annulus calcification (MAC) is a chronic, non-inflammatory, degenerative mechanism of the fibrous base of the mitral valve. While MAC was originally thought to be an age-related degenerative process, there is evidence that other mechanisms, such as atherosclerosis and abnormal calcium phosphorus metabolism, also contribute to the development of MAC. AREAS COVERED This paper summarizes, existing perception of clinically valid definition of MAC and the pathophysiological processes that lead to the development of MAC and the diagnostic implications of this disease entity. EXPERT OPINION Minimal evidence exists on the natural history and progression of MAC. Characterization of MAC progression and identification of predisposing risk factors can help to validate hypotheses. MAC is most commonly asymptomatic and incidental finding. Echocardiography is the primary imaging modality for identification and characterization of MAC and associated mitral valve (MV) disease. For patients with an indication for MV surgery, computed tomography (CT) is a complementary imaging modality for MAC. MAC is generally recognized by its characteristic density, location, and shape on echocardiography and CT, unusual variants are sometimes confused with other lesions.
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Affiliation(s)
- Divya Birudaraju
- Division Of Cardiology, Lundquist Institute For Biomedical Innovation At Harbor-UCLA, Torrance, California, USA
| | - Lavanya Cherukuri
- Division Of Cardiology, Lundquist Institute For Biomedical Innovation At Harbor-UCLA, Torrance, California, USA
| | - Shruthi Pranesh
- Division Of Cardiology, Penn State Holy Spirit Hospital, Harrisburg, Pennsylvania, USA
| | - Matthew J Budoff
- Division Of Cardiology, Lundquist Institute For Biomedical Innovation At Harbor-UCLA, Torrance, California, USA
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Eberhard M, Hinzpeter R, Schönenberger ALN, Euler A, Kuzo N, Reeve K, Stähli BE, Kasel AM, Manka R, Tanner FC, Alkadhi H. Incremental Prognostic Value of Coronary Artery Calcium Score for Predicting All-Cause Mortality after Transcatheter Aortic Valve Replacement. Radiology 2021; 301:105-112. [PMID: 34342499 DOI: 10.1148/radiol.2021204623] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Current risk models show limited performances for predicting all-cause mortality after transcatheter aortic valve replacement (TAVR). Purpose To determine the prognostic value of coronary artery calcium (CAC) scoring for predicting 30-day and 1-year mortality in patients undergoing TAVR. Materials and Methods In this single-center institutional review board-approved secondary analysis of prospectively collected data (SwissTAVI Registry), the authors evaluated participants who, before TAVR, underwent CT that included a nonenhanced electrocardiography-gated cardiac scan between May 2008 and September 2019 and who had not undergone previous coronary revascularization. Clinical data, including the European System for Cardiac Operative Risk Evaluation (EuroSCORE II), were recorded. The CAC score was determined, and 30-day and 1-year all-cause mortality were assessed by using Cox regression analyses. Results In total, 309 participants (mean age ± standard deviation, 81 years ± 7; 175 women) were included, with a median CAC score of 334 (interquartile range, 104-987). Seventy-seven of the 309 participants (25%) had a CAC score greater than or equal to 1000. A CAC score of 1000 or greater served as an independent predictor of 30-day (hazard ratio [HR], 4.5 [95% CI: 1.5, 13.6] compared with a CAC score <1000; P = .007) and 1-year (HR, 4.3 [95% CI: 1.5, 12.7] compared with a CAC score of 0-99; P = .008) mortality after TAVR. Similar trends were observed for each point increase of the EuroSCORE II as an independent predictor of 30-day (HR, 1.22 [95% CI: 1.10, 1.36]; P < .001) and 1-year (HR, 1.16 [95% CI: 1.08, 1.25]; P < .001) mortality. Adding the CAC score to the EuroSCORE II provided incremental prognostic value for 1-year mortality after TAVR over the EuroSCORE II alone (concordance index, 0.76 vs 0.69; P = .04). Conclusion In participants without prior coronary revascularization, the coronary artery calcium score represented an independent predictor of 30-day and 1-year mortality after transcatheter aortic valve replacement. ClinicalTrials.gov identifier, NCT01368250 © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Almeida in this issue.
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Affiliation(s)
- Matthias Eberhard
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland (M.E., R.H., A.L.N.S., A.E., R.M., H.A.); Department of Cardiology, University Heart Center Zurich (N.K., B.E.S., A.M.K., R.M., F.C.T.), and Epidemiology, Biostatistics and Prevention Institute (K.R.), University of Zurich, Zurich, Switzerland; and Institute for Biomedical Engineering, Swiss Federal Institute of Technology in Zurich (ETH), Zurich, Switzerland (R.M.)
| | - Ricarda Hinzpeter
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland (M.E., R.H., A.L.N.S., A.E., R.M., H.A.); Department of Cardiology, University Heart Center Zurich (N.K., B.E.S., A.M.K., R.M., F.C.T.), and Epidemiology, Biostatistics and Prevention Institute (K.R.), University of Zurich, Zurich, Switzerland; and Institute for Biomedical Engineering, Swiss Federal Institute of Technology in Zurich (ETH), Zurich, Switzerland (R.M.)
| | - Amadea L N Schönenberger
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland (M.E., R.H., A.L.N.S., A.E., R.M., H.A.); Department of Cardiology, University Heart Center Zurich (N.K., B.E.S., A.M.K., R.M., F.C.T.), and Epidemiology, Biostatistics and Prevention Institute (K.R.), University of Zurich, Zurich, Switzerland; and Institute for Biomedical Engineering, Swiss Federal Institute of Technology in Zurich (ETH), Zurich, Switzerland (R.M.)
| | - Andre Euler
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland (M.E., R.H., A.L.N.S., A.E., R.M., H.A.); Department of Cardiology, University Heart Center Zurich (N.K., B.E.S., A.M.K., R.M., F.C.T.), and Epidemiology, Biostatistics and Prevention Institute (K.R.), University of Zurich, Zurich, Switzerland; and Institute for Biomedical Engineering, Swiss Federal Institute of Technology in Zurich (ETH), Zurich, Switzerland (R.M.)
| | - Nazar Kuzo
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland (M.E., R.H., A.L.N.S., A.E., R.M., H.A.); Department of Cardiology, University Heart Center Zurich (N.K., B.E.S., A.M.K., R.M., F.C.T.), and Epidemiology, Biostatistics and Prevention Institute (K.R.), University of Zurich, Zurich, Switzerland; and Institute for Biomedical Engineering, Swiss Federal Institute of Technology in Zurich (ETH), Zurich, Switzerland (R.M.)
| | - Kelly Reeve
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland (M.E., R.H., A.L.N.S., A.E., R.M., H.A.); Department of Cardiology, University Heart Center Zurich (N.K., B.E.S., A.M.K., R.M., F.C.T.), and Epidemiology, Biostatistics and Prevention Institute (K.R.), University of Zurich, Zurich, Switzerland; and Institute for Biomedical Engineering, Swiss Federal Institute of Technology in Zurich (ETH), Zurich, Switzerland (R.M.)
| | - Barbara E Stähli
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland (M.E., R.H., A.L.N.S., A.E., R.M., H.A.); Department of Cardiology, University Heart Center Zurich (N.K., B.E.S., A.M.K., R.M., F.C.T.), and Epidemiology, Biostatistics and Prevention Institute (K.R.), University of Zurich, Zurich, Switzerland; and Institute for Biomedical Engineering, Swiss Federal Institute of Technology in Zurich (ETH), Zurich, Switzerland (R.M.)
| | - Albert M Kasel
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland (M.E., R.H., A.L.N.S., A.E., R.M., H.A.); Department of Cardiology, University Heart Center Zurich (N.K., B.E.S., A.M.K., R.M., F.C.T.), and Epidemiology, Biostatistics and Prevention Institute (K.R.), University of Zurich, Zurich, Switzerland; and Institute for Biomedical Engineering, Swiss Federal Institute of Technology in Zurich (ETH), Zurich, Switzerland (R.M.)
| | - Robert Manka
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland (M.E., R.H., A.L.N.S., A.E., R.M., H.A.); Department of Cardiology, University Heart Center Zurich (N.K., B.E.S., A.M.K., R.M., F.C.T.), and Epidemiology, Biostatistics and Prevention Institute (K.R.), University of Zurich, Zurich, Switzerland; and Institute for Biomedical Engineering, Swiss Federal Institute of Technology in Zurich (ETH), Zurich, Switzerland (R.M.)
| | - Felix C Tanner
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland (M.E., R.H., A.L.N.S., A.E., R.M., H.A.); Department of Cardiology, University Heart Center Zurich (N.K., B.E.S., A.M.K., R.M., F.C.T.), and Epidemiology, Biostatistics and Prevention Institute (K.R.), University of Zurich, Zurich, Switzerland; and Institute for Biomedical Engineering, Swiss Federal Institute of Technology in Zurich (ETH), Zurich, Switzerland (R.M.)
| | - Hatem Alkadhi
- From the Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland (M.E., R.H., A.L.N.S., A.E., R.M., H.A.); Department of Cardiology, University Heart Center Zurich (N.K., B.E.S., A.M.K., R.M., F.C.T.), and Epidemiology, Biostatistics and Prevention Institute (K.R.), University of Zurich, Zurich, Switzerland; and Institute for Biomedical Engineering, Swiss Federal Institute of Technology in Zurich (ETH), Zurich, Switzerland (R.M.)
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Tsianaka T, Matziris I, Kobe A, Euler A, Kuzo N, Erhart L, Leschka S, Manka R, Kasel AM, Tanner FC, Alkadhi H, Eberhard M. Mitral annular disjunction in patients with severe aortic stenosis: Extent and reproducibility of measurements with computed tomography. Eur J Radiol Open 2021; 8:100335. [PMID: 33748350 PMCID: PMC7960936 DOI: 10.1016/j.ejro.2021.100335] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 01/08/2023] Open
Abstract
Mitral annulus disjunction (MAD) is frequent in patients with severe aortic stenosis. Computed tomography enables a highly reproducible assessment of MAD. MAD patients significantly more often have mitral valve prolapse.
Objectives To determine with CT the prevalence and extent of mitral annular disjunction (MAD) in patients undergoing transcatheter aortic valve replacement (TAVR) and its association with mitral valve disease and arrhythmia. Methods We retrospectively evaluated 408 patients (median age, 82 years; 186 females) with severe aortic stenosis undergoing ECG-gated cardiac CT with end-systolic data acquisition. Baseline and follow-up data were collected in the context of a national registry. Two blinded, independent observers evaluated the presence of MAD on multi-planar reformations. Maximum MAD distance (left atrial wall-mitral leaflet junction to left ventricular myocardium) and circumferential extent of MAD were assessed on CT using dedicated post-processing software. Associated mitral valve disease was determined with echocardiography. Results 7.8 % (32/408) of patients with severe aortic stenosis had MAD. The maximum MAD was 3.5 mm (interquartile range: 3.0–4.0 mm). The circumferential extent of MAD comprised 34 ± 15 % of the posterior and 26 ± 12 % of the entire mitral annulus. Intra- and interobserver agreement for the detection of MAD on CT were excellent (kappa: 0.90 ± 0.02 and 0.92 ± 0.02). Mitral regurgitation (p = 1.00) and severe mitral annular calcification (p = 0.29) were similarly prevalent in MAD and non-MAD patients. Significantly more patients with MAD (6/32; 19 %) had mitral valve prolapse compared to those without (6/376; 2 %; p < 0.001). MAD was not associated with arrhythmia before and after TAVR (p > 0.05). Conclusions Using CT, MAD was found in 7.8 % of patients with severe aortic stenosis, with a higher prevalence in patients with mitral valve prolapse. We found no association of MAD with arrhythmia before or after TAVR.
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Affiliation(s)
- T Tsianaka
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - I Matziris
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
| | - A Kobe
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - A Euler
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - N Kuzo
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
| | - L Erhart
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
| | - S Leschka
- Division of Radiology and Nuclear Medicine, Kantonsspital St.Gallen, Switzerland
| | - R Manka
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland.,Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - A M Kasel
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
| | - F C Tanner
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
| | - H Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - M Eberhard
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
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