Risk factors and clinical outcomes associated with mitral annular calcification in hypertrophic obstructive cardiomyopathy: a retrospective analysis

OBJECTIVE: This study aimed to identify risk factors associated with mitral annular calcification (MAC) in patients with hypertrophic obstructive cardiomyopathy (HOCM) and to evaluate its relationship with clinical outcomes. METHODS: A total of 310 patients with HOCM who underwent interventricular septal myectomy were retrospectively analyzed. Patients were divided into a MAC group (n = 24) and a non-MAC group (n = 286). Demographic characteristics, echocardiographic parameters, and clinical data were compared between groups. Major adverse cardiovascular and cerebrovascular event (MACCE) and circulating levels of brain natriuretic peptide, Apelin, and Galectin-3 were analyzed. RESULTS: Patients with MAC were older and showed higher prevalence of aortic annular calcification, mitral leaflet thickening, and moderate-to-severe tricuspid regurgitation (P < 0.05). Multivariate analysis identified gender, age, aortic annular calcification, moderate-to-severe tricuspid regurgitation, and mitral leaflet thickening as independent risk factors for MAC. Patients with MAC showed larger left ventricular end-diastolic volume, reduced left ventricular ejection fraction, and greater left atrium mass, and a higher incidence of MACCE than those without MAC (P < 0.05). CONCLUSION: In HOCM undergoing septal myectomy, MAC is associated with adverse cardiac remodeling and unfavorable clinical outcomes. Identification of related factors may aid risk stratification and perioperative management.