Echocardiographic Characteristics, Measures of Severity and Natural History of Isolated Calcific Mitral Stenosis.

IntroductionWith improved life expectancy, mitral annular calcification and calcific mitral stenosis (CMS) are increasing in prevalence. Echocardiographic evaluation of CMS is challenging due to acoustic shadowing and lack of CMS specific data on assessment of severity and outcomes. MethodsWe retrospectively identified patients with isolated CMS between the years 1/1/2010 and 4/5/2022. Severe CMS was defined as MVAcont [&le;]1.5 cm2. The primary outcome was a composite of all-cause mortality, mitral valve replacement (MVR) and ischemic stroke. Outcomes were collected through electronic health records with follow up through 8/15/2025. ResultsOur cohort included a total of n=717 patients with CMS of which n=140 had severe CMS. The mean age was 74{+/-}13 years and cohort was predominantly female. We found that MVAPHT consistently overestimates the MVA and is a poor predictor of severe CMS. Mean gradient >5 mm Hg had 81% specificity and 57% sensitivity for severe CMS. Over a median follow up of 36 (IQR 10.5-49.7) months, a total of n=331 (46.2%) patients died, and the primary composite outcome occurred in n=370 (51.6%). Although MVAcont [&le;]1.5 cm2 [aHR 1.3 (95% CI 0.9-1.8),p=0.29] was not an independent predictor of the primary outcome we found that mTMG was a significant independent predictor primary outcome [aHR 1.5 (95% CI 1.1-2), p<0.01]. Patients with MVAcont [&le;]1.5 cm2 and mean gradient [&ge;] 5 mmHg had the highest risk for the primary outcome [aHR 2 (95% CI 1.1-3.7),p=.02]. ConclusionPatients with severe CMS are older, female with a high burden of comorbidities and carry an overall poor prognosis. mTMG is an independent prognostic marker in these patients. Patients with MVA [&le;]1.5 cm2 and mTMG [&ge;]5 mmHg have the worst prognosis.