Characteristics and Implications of Left Atrial Calcium on Cardiac Computed Tomography in Patients With Earlier Mitral Valve Operation

https://doi.org/10.1016/j.amjcard.2020.04.050Get rights and content

Left atrial calcium (LAC) is often observed in patients who have undergone mitral valve (MV) surgery, but little is known about its characteristics and clinical implications. Therefore, we sought to investigate the structural and hemodynamic significance of LAC and its association with clinical outcomes. We investigated 327 patients with repaired or prosthetic MV who underwent cardiac CT from 2010 to 2017. The degree of LAC was analyzed and classified into three groups: group 1 (no LAC), group 2 (mild-to-moderate LAC), and group 3 (severe LAC). Clinical and echocardiographic characteristics and clinical outcomes were compared in three groups. LAC was seen in 79 (24.2%) patients. Groups 2 and 3 showed more prevalent atrial fibrillation, a rheumatic etiology, a higher number of previous surgeries, a larger LA volume index, and higher pulmonary artery systolic pressure than group 1. Paravalvular leakage of the MV increased progressively according to severity of LAC (15.4% in group 1, 39.3% in group 2, and 66.7% in group 3, p <0.001). Event-free survival rate for major adverse cardiovascular adverse events (log rank p = 0.033) and all-cause mortality (log rank p <0.001) were significantly different according to LAC group. In Cox regression analyses, presence of severe LAC was an independent predictor of all-cause mortality (hazard ratio: 4.44, 95% confidence interval: 1.71 to 11.58, p = 0.002). LAC on cardiac CT is not uncommon and reflects more advanced LA remodeling and a stiff LA. The presence and severity of LAC are associated with a worse clinical outcome after MV surgery.

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Methods

We retrospectively searched the database for cardiac CT examinations performed between March 2010 and December 2017. We included 327 patients with MV surgery, MV repair or replacement, as the study population. Patients who underwent surgical ablation or radiofrequency catheter ablation for atrial fibrillation were not included. Demographic data and information on the surgical findings were collected from patient electronic medical records. Cardiac CT was performed by clinician's discretion when

Results

The study population consisted of 327 patients. The mean age was 61 years, and 216 patients (66.1%) were women. The overall incidence of LAC was 24.5% (80 cases). Mild-to-moderate LAC was present in 56 cases (17.1%), whereas severe LAC was seen in 24 cases (7.3%). The baseline clinical and echocardiographic characteristics were compared among the groups (Table 1). There was no significant difference in age, gender, or underlying disease, such as hypertension, diabetes mellitus, and chronic

Discussion

The principal findings of the present study were that (1) LAC is not a rare finding in patients who have undergone MV surgery; (2) LAC is associated with rheumatic heart disease, large LA volume index, longer time interval after initial MV operation, previous LA appendage ligation and the higher number of previous MV surgeries; (3) presence and severity of LAC were associated with elevated pulmonary artery systolic pressure and significantly higher incidence of PVL; and (4) presence of severe

Author Contribution

Jah Yeon Choi: Investigation, Formal analysis, Writing - Original draft preparation, Resources, Young Joo Suh: Resources, Validation, Young Jin Kim: Resources, Validation, Seung-Hyun Lee: Resources, Investigation, Sak Lee: Resources, Investigation, Geu-Ru Hong: Investigation, Resources, Conceptualization, Jong-Won Ha: Investigation, Resources, Chi Young Shim: Conceptualization, Supervision, Reviewing and Editing, Formal analysis, Resources, Methodology

Disclosures

The authors have no conflict of interest to report.

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Funding: None.

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