Association of Mitral Annular Calcification with Left Ventricular Mechanics: A Speckle Tracking Study

Background: Mitral annular calcification (MAC) is a common echocardiographic finding in clinical practice and is associated with cardiovascular risk factors and atherosclerosis. However, data regarding left ventricular (LV) functions are lacking. We aimed to evaluate the relationship between MAC and LV mechanical functions with the utility of two-dimensional speckle tracking echocardiography (2DSTE).

Methods: The study involved 91 patients with MAC and 48 control subjects. Mitral annular thickness of 1-2 mm was reported as mild, 2-5 mm as moderate, and >5 mm as severe MAC. All patients underwent 2D echocardiography.

Results: MAC was observed in 91 (65.5%) patients. Of LV diastolic parameters, E/Em ratio, LAVI, LV mass index, and t-LV UR were increased. Of LV systolic parameters, GLS and Sm were decreased, whereas Ar, Ar-rate systole, peak LV twist, peak LV twist rate, LV-tor, and MPI were increased, which were all correlated with presence and severity of MAC. Multivariate linear regression analysis showed that LV mass index (β = 0.225, P = 0.012), t-LV UR (β = 0.370, P < 0.001), LV mass index (β = 0.183, P = 0.025), MPI (β = 0.288, P < 0.001), and GLS (β = -0.385, P < 0.001) were significantly associated with MAC severity.

Conclusion: The presence and severity of MAC is associated with impaired LV systolic and diastolic functions. Therefore, preventive strategies might be taken in patients with MAC to avoid LV systolic and diastolic dysfunction.