CT mitral-valve calcium adds little to the wilkins score for immediate PTMC success

Abstract Background The Wilkins echocardiographic score guides selection for percutaneous transvenous mitral commissurotomy (PTMC), but its calcification sub-score is qualitative. Whether quantified mitral-valve calcium (MVC) on computed tomography (CT) refines outcome prediction remains unknown. Purpose To determine whether CT-derived MVC scoring adds prognostic value to the Wilkins score for immediate haemodynamic success after PTMC. Methods Thirty consecutive adults with severe rheumatic mitral stenosis, all candidates for PTMC, were prospectively enrolled in a single-centre pilot study. Pre-procedural evaluation comprised transthoracic echocardiography for Wilkins scoring and non-contrast cardiac CT for Agatston MVC scoring (mid-diastolic acquisition, 120 kV). Procedural success was defined as a ≥ 50 % reduction in left-atrial pressure, assessed invasively, without the development of ≥ moderate mitral regurgitation on post-procedural echocardiography. Results The cohort’s mean age was 48 ± 15 years. Eighteen patients (60 %) achieved procedural success. Baseline structural and haemodynamic indices—including right-ventricular dimension, left-ventricular size, interventricular septal thickness, left-ventricular ejection fraction, left-atrial volume and early diastolic transmitral velocity—were comparable between success and failure groups (all p > 0.05). Individual Wilkins components were similarly distributed (leaflet thickening, mobility and calcification grade 2 in ≥ 75 % of patients; sub-valvular thickening grade 3 in ≥ 80 %). Median total Wilkins score was lower in successes (8 [IQR 8–9]) than in failures (9 [9–10]); p = 0.01. CT showed minimal leaflet calcification. Median MVC score was 0 (0–0) in successes and 0 (0–13.25) in failures (p = 0.45); calcium mass 0 mg (0–0) vs 0 mg (0–3.40) (p = 0.28) and volume 0 mm³ (0–0) vs 0 mm³ (0–22.40) (p = 0.28). A zero MVC score was associated with a higher, though non-significant, success rate (47.8 % vs 28.6 %; p = 0.32). Conclusions In this pilot cohort, quantitative CT MVC did not improve the prediction of immediate PTMC success beyond the Wilkins score, largely because CT identifiable leaflet calcification was uncommon. Echocardiography, therefore, remains the principal selection tool. Larger multicentre studies encompassing patients with a wider calcium burden are needed to clarify the incremental value of CT calcium quantification.