Mitral annular calcification volume predicts one year all-cause mortality after transcatheter aortic-valve implantation

Introduction Visual qualitative assessment of mitral annular calcification (MAC) suggests a prognostic impact after transcatheter aortic-valve implantation (TAVI). Purpose We aimed to show the impact of a quantitative assessment of MAC volume on one year all-cause mortality in patients treated with TAVI. Methods Patients from a national registry that encompassed all consecutive patients treated with TAVI between 2010 and 2014 in four centers were included. MAC volume was quantitatively assessed on pre-TAVI computed tomography (CT) with a semi-automatic dedicated software. Patients with unavailable CT or with mechanical mitral valve were excluded. MAC volume was considered either as a categorical variable for Kaplan–Meier analysis (log rank test) or as a continuous variable for the Cox model. A multivariate Cox model adjusted for age, sex, atrial fibrillation, peripheral artery disease, estimated glomerular filtration rate (eGFR), left ventricular ejection fraction (LVEF), vascular approach and aortic regurgitation post implantation > 2/4 was performed. Results A total of 1468 patients aged 83.5 ± 7 years were included. Mean eGFR and LVEF were 50 ± 22.8 mL/mn and 56 ± 14%, respectively. Transfemoral approach was used in 1018/1464 patients (69%). The most calcified decile concerned 149 patients, who had ≥ 2 cm3 MAC volume. After one year follow-up, 245/1442 patients (17%) died, 211/1293 (16,3%) in patients with  Fig. 1 . In univariate survival analysis, MAC volume was associated with a higher all-cause mortality; HR 1,11; 95% confidence interval (CI) [1.035–1.191]; P = 0.004. In multivariate survival analysis, MAC volume was still associated with higher all-cause mortality, for every cm3 increase in MAC volume; HR 1.106; 95% CI [1.027–1.191]; P = 0.008. Conclusion MAC volume assessed quantitatively is a predictor of one-year all-cause mortality after TAVI.