Impacts of Mitral Annular Calcification on Heart Failure With Preserved Ejection Fraction

Mitral annular calcification (MAC) and heart failure with preserved ejection fraction (HFpEF) share risk factors but links between the 2 have not been well studied. Using data from the TriNetX US Collaborative Network various cohorts were created which were propensity score matched (by demographics and comorbidities) and used to perform 3 studies: 1) All hospitalized patients between 2020 and 2023, without prior heart failure, were stratified by presence or absence of MAC to assess risk of developing HFpEF at 1 year. 2) Patients with a HFpEF diagnosis were stratified by presence or absence of a new diagnosis of MAC between 2020 and 2023 and evaluated for cardiovascular outcomes at 1 year. 3) Data from study-1 were further explored for interactions between MAC and body-mass index (BMI) in development of HFpEF at 1 year. In study-1, MAC patients were at higher risk of developing HFpEF versus no-MAC (HR 3.80, p < 0.0001). In study-2, HFpEF patients with vs without MAC were at higher risk of HF hospitalization (HR 1.24, p < 0.0001), all-cause hospitalization (HR 1.34, p < 0.0001), and various cardiovascular outcomes. In study-3, incident HFpEF in the no-MAC group was low with a "J-shaped" curve noted across BMI quintiles. MAC patients had a much higher incidence of HFpEF with little influence of BMI except in the highest quintile. In conclusion: MAC is an independent risk factor for development of HFpEF. When present in HFpEF patients, there is increased risk of re-hospitalization and cardiovascular events. MAC has much greater impact on development of HFpEF than does BMI.