Mitral Annular Calcification Score Determined by 3-D Transesophageal Echocardiography vs Cardiac Computed Tomography
Year: 2025
Type: article
Abstract: BACKGROUND: A cardiac computed tomography (CT)-based mitral annular calcification (MAC) scoring system systematically grades MAC severity, but its correlation with three-dimensional transesophageal echocardiography (3D-TEE) remains unclear. OBJECTIVES: The authors aimed to compare MAC severity assessment by 3D-TEE vs CT and evaluate their associations with hemodynamic parameters indicative of mitral valve disease. METHODS: We analyzed patients with MAC enrolled in the MITRAL (Mitral Implantation of TRAnscathether vaLves) II trial (NCT04408430) across 13 centers undergoing transcatheter mitral valve replacement screening. Core laboratories assessed MAC severity using 3D-TEE and CT. Correlation and agreement were assessed via Spearman and intraclass correlation coefficients. Hemodynamic parameters of mitral stenosis (MS) and regurgitation were obtained from two-dimensional transthoracic echocardiography (2D-TTE) and 3D-TEE. Linear regression evaluated associations with MAC scores. RESULTS: decrease in 2D-TTE mitral valve area, and an increase in mean diastolic pressure gradient (1 mm Hg by 3D-TEE; 0.96 mm Hg by 2D-TTE). 3D-TEE MAC scores showed no significant correlation with regurgitation parameters. CT-MAC scores showed weak, nonsignificant correlations with both MS and mitral regurgitation. CONCLUSIONS: 3D-TEE provides complementary and functionally relevant MAC assessment, correlating with MS severity. It may serve as a useful adjunct to CT in transcatheter mitral valve replacement evaluation, especially when contrast imaging is limited.
Source: JACC Advances
Authors: Karol Quelal Analuisa, Apurva Challa, Conor Lane, Abdullah Al-abcha, Isaac George, Brian K. Whisenant, Lowell F. Satler, Raj R. Makkar, Paul D. Mahoney, Firas E. Zahr, Harsh Golwala, Pinak Bipin Shah, Ignacio Inglessis-Azuaje, Thomas Waggoner, Kamran Muhammad, Marvin H. Eng, Tatiana Kaptzan, Bradley Lewis, Jeremy Thaden, Jared Bird, Eric E. Williamson, Jeremy Collins, Mackram F. Eleid, Jae K. Oh, Mayra E. Guerrero
Institutions: Mayo Clinic, Columbia University Irving Medical Center, Intermountain Healthcare, MedStar Washington Hospital Center, Endeavor Health, University of Pittsburgh Medical Center, Oregon Health & Science University, Brigham and Women's Hospital, Harvard University, Massachusetts General Hospital, Oklahoma Heart Institute, Banner - University Medical Center Phoenix
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,936
Funder: Edwards Lifesciences
OpenAlex ID: W4417440342