Increased Amounts of Epicardial Fat Tissue Are Not Associated With Mitral Annular Calcification in Patients With Severe Aortic Stenosis Planned for Transcatheter Aortic Valve Implantation

Background

Mitral annular calcification (MAC) is a common finding in the elderly that is associated with worse outcomes. It is postulated that MAC is a different form of atherosclerosis. Epicardial fat tissue (EFT) is in close contact with different heart structures and is especially pronounced in the atrioventricular grooves and the area surrounding the atrioventricular valve apparatus. The amount of EFT is associated with the extent of coronary artery disease, including plaque burden and coronary calcification. The aim of this study was to investigate whether EFT is also associated with the extent of MAC.

Methods

In this retrospective analysis of n = 543 (53.6% female) consecutive patients with high-grade aortic stenosis, EFT volume and MAC were assessed in the pre-transcatheter aortic valve implantation computed tomography scans. Patients with no/mild MAC and moderate/severe MAC were compared in terms of EFT volume and baseline, procedural, and postprocedural characteristics. Univariate and multivariable regression analyses were performed with MAC as dependent variable.

Results

Over one-quarter (n = 154; 28.4%) of the patients had moderate or severe MAC. The EFT volume between those with moderate/severe MAC and those with little or no MAC did not differ significantly: 130 (interquartile range 94-164) cm³ vs. 133 (interquartile range 95-176) cm³; p = 0.704. Accordingly, EFT volume did not predict increased MAC. Female sex, atrial fibrillation, and prior pacemaker implantation were independent predictors of moderate/severe MAC.

Conclusions

Increased EFT is not a predictor of MAC, and thus its unfavorable proinflammatory properties do not seem to play a significant role in the development of MAC.