Mitral Annulus Calcification: Pathophysiology, Outcome, and Imaging Evaluation

Mitral annulus calcification (MAC) is a chronic, degenerative process characterized by calcium deposition in the mitral annulus. It is commonly observed in elderly individuals and those with chronic kidney disease, hypertension, and metabolic disorders. MAC has been increasingly recognized as a marker of cardiovascular disease and is associated with adverse clinical outcomes, including mitral valve dysfunction, arrhythmias, and increased cardiovascular mortality. The pathophysiology of MAC involves endothelial dysfunction, chronic inflammation, and osteogenic differentiation of valvular interstitial cells, driven by risk factors such as aging, chronic kidney disease, diabetes mellitus, and hypertension. Imaging modalities, including echocardiography and computed tomography (CT) play a crucial role in the diagnosis, assessment, and risk stratification of MAC. The presence of MAC complicates mitral valve interventions, making surgical and transcatheter approaches challenging. Despite advancements in imaging and therapeutic strategies, MAC remains a significant challenge in cardiovascular medicine, necessitating further research into its pathophysiology, optimal management strategies, and long-term outcomes.