Mitral Annular Calcification (MAC) is a degenerative condition affecting many elderly patients with cardiovascular risk factors, often leading to mitral valve dysfunction (MVD). Among patients with severe aortic stenosis (AS), MAC is prevalent, yet the impact of its severity and associated MVD on patient outcomes remains unclear.

The aim of this study was to examine the prevalence of MAC and associated MVD to MAC among patients with severe AS and to assess their prognostic significance.

This retrospective study included 613 patients with severe AS. Patients were categorized by echocardiographic MAC severity, and the presence of MVD defined as a mean transmitral gradient (mTMG)≥5mmHg.

Of the 613 patients, 309 (50.4%) had MAC (44% mild, 40% moderate and 16% severe), with 21% also exhibiting MVD. Patients with MAC had lower 6-year survival (47±3% vs. 64±3%, log-rank P<0.001) even after adjustment by covariates of potential prognostic impact (Adjusted HR [95%CI]=1.43 [1.08–1.90]) (Figure 1). Severe MAC was associated with older age, female sex, higher comorbidity scores and elevated pulmonary pressures (all P<0.05), and with lower 6-year survival (23±7%) compared to mild (55±5%) or moderate MAC (50±5%) (Figure 2). Patients with both MAC and MVD showed a 6-year survival rate of 28±7%, notably lower than the 53±4% in those with MAC but no MVD (Figure 3). Multivariable analysis indicated that severe MAC (Adjusted HR [95%CI]=2.75 [1.67–4.50]) and MVD (Adjusted HR [95%CI]=2.08 [1.36–3.15]) were independent predictors of mortality (Figure 1, Figure 2, Figure 3).

MAC is highly prevalent among severe AS, present in more than 50% of patients. MAC is associated with reduced survival, particularly when mitral calcification are severe or in presence of MVD. This study emphasizes the importance of evaluating MAC severity and mTMG in AS patients to guide clinical decisions.