Mitral annular calcification in the elderly – Quantitative assessment

• Published in: Journal of cardiovascular computed tomography 2021-03, Vol.15 (2), p.161-166
• Main Authors: Eberhard, M., Schönenberger, A.L.N., Hinzpeter, R., Euler, A., Sokolska, J., Weber, L., Kuzo, N., Manka, R., Kasel, A.M., Tanner, F.C., Alkadhi, H.
• Format: Article
• Language: English
• Subjects: 80 and over; Aged; Calcification; Computed tomography; Mitral valve; Mitral valve stenosis
• ISSN: 1934-5925; 1876-861X
• DOI: 10.1016/j.jcct.2020.06.001

To determine the reliability of subjective and objective quantification of mitral annular calcification (MAC) in elderly patients with severe aortic stenosis, to define quantitative sex- and age-related reference values of MAC, and to correlate quantitative MAC with mitral valve disease. In this retrospective, IRB-approved study, we included 559 patients (268 females, median age 81 years, inter-quartile range 77–85 years) with severe aortic stenosis undergoing CT. Four independent readers performed subjective MAC categorization as follows: no, mild, moderate, and severe MAC. Two independent readers performed quantitative evaluation of MAC using the Agatston score method (AgatstonMAC). Mitral valve disease was determined by echocardiography. Subjective MAC categorization showed high inter-reader agreement for no (k ​= ​0.88) and severe MAC (k ​= ​0.75), whereas agreement for moderate (k ​= ​0.59) and mild (k ​= ​0.45) MAC was moderate. Intra-reader agreement for subjective MAC categorization was substantial (k ​= ​0.69 and 0.62). Inter- and intra-reader agreement for AgatstonMAC were excellent (ICC ​= ​0.998 and 0.999, respectively), with minor inconsistencies in MAC involving the left ventricular outflow tract/aortic valve. There were significantly more women than men with MAC (n ​= ​227, 85% versus n ​= ​209, 72%; p ​