P17 MITRAL ANNULUS CALCIFICATION IN TRANSCATHETER AORTIC VALVE IMPLANTS

Abstract

Abstract Background Mitral annular calcium (MAC) is a common finding in patients undergoing transcatheter aortic valve implantation (TAVI). However, assessment of MAC in the pre–TAVI diagnostic pathway is not among the procedures routinely performed. Aim of the study In this retrospective study conducted in patients undergoing TAVI, we evaluated (1) the presence and extent of MAC using a multimodal imaging approach; (2) the clinical and structural factors associated with it; and (3) the possible prognostic role of MAC. Methods Between 2016 and 2022, 62 patients with severe aortic stenosis underwent TAVI at the Cardiovascular Department of A.O.U. Careggi (Florence, Italy). Baseline and post–TAVI clinical and echocardiographic data were collected at Santo Stefano Hospital (Prato, Italy). MAC assessment was performed by quantitative analysis on echocardiographic and computed tomography (CT) images, obtaining a MAC severity score. A clinical follow–up was conducted at 30–day intervals in all patients. Results MAC was detected in 48 patients (77%), a severe MAC in 16 patients (26%). CT analysis was more accurate in defining the presence and extent of MAC. Patients with MAC were more female, older in age, with greater cardiovascular risk profile and comorbidities; they presented more frequently mitral valvulopathy and arrhythmias. These differences were amplified by stratifying the population according to MAC severity score. Patients with severe MAC had a pattern of ventricular remodeling with predominantly concentric hypertrophy. Post–TAVI, patients with severe MAC had less hemodynamic benefit and a greater need for pacemaker implantation. A trend of increasing all–cause mortality as MAC score increased was noted. Conclusions Assessment of mitral annular calcium and its extension should become an integral part of the patient‘s pre–TAVI risk stratification process. A phenotypic pattern of concentric left ventricular hypertrophy, mainly associated with patients with severe MAC, identifies a category with lower post procedural recovery.