{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T00:14:03Z","timestamp":1794269643233,"version":"4.9.0"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"45","license":[{"start":{"date-parts":[[2020,11,22]],"date-time":"2020-11-22T00:00:00Z","timestamp":1606003200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000863","name":"Ellison Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000863","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","award":["R01 HL141917"],"award-info":[{"award-number":["R01 HL141917"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims\u2003<\/jats:title>\n                  <jats:p>The aim of this study was to define the natural history of patients with mitral annular calcification (MAC)-related mitral valve dysfunction and to assess the prognostic importance of mean transmitral pressure gradient (MG) and impact of concomitant mitral regurgitation (MR).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results\u2003<\/jats:title>\n                  <jats:p>The institutional echocardiography database was examined from 2001 to 2019 for all patients with MAC and MG \u22653 mmHg. A total of 5754 patients were stratified by MG in low (3\u20135 mmHg, n\u2009=\u20093927), mid (5\u201310 mmHg, n\u2009=\u20091476), and high (\u226510 mmHg, n\u2009=\u2009351) gradient. The mean age was 78\u2009\u00b1\u200911 years, and 67% were female. MR was none\/trace in 32%, mild in 42%, moderate in 23%, and severe in 3%. Primary outcome was all-cause mortality, and outcome models were adjusted for age, sex, and MAC-related risk factors (hypertension, diabetes, coronary artery disease, chronic kidney disease). Survival at 1, 5, and 10 years was 77%, 42%, and 18% in the low-gradient group; 73%, 38%, and 17% in the mid-gradient group; and 67%, 25%, and 11% in the high-gradient group, respectively (log-rank P\u2009&amp;lt;\u20090.001 between groups). MG was independently associated with mortality (adjusted HR 1.064 per 1\u2009mmHg increase, 95% CI 1.049\u20131.080). MR severity was associated with mortality at low gradients (P\u2009&amp;lt;\u20090.001) but not at higher gradients (P\u2009=\u20090.166 and 0.372 in the mid- and high-gradient groups, respectively).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion\u2003<\/jats:title>\n                  <jats:p>In MAC-related mitral valve dysfunction, mean transmitral gradient is associated with increased mortality after adjustment for age, sex, and MAC-related risk factors. Concomitant MR is associated with excess mortality in low-gradient ranges (3\u20135 mmHg) but gradually loses prognostic importance at higher gradients, indicating prognostic utility of transmitral gradient in MAC regardless of MR severity.<\/jats:p>\n                  <jats:p\/>\n               <\/jats:sec>","DOI":"10.1093\/eurheartj\/ehaa819","type":"journal-article","created":{"date-parts":[[2020,9,23]],"date-time":"2020-09-23T11:52:16Z","timestamp":1600861936000},"page":"4321-4328","source":"Crossref","is-referenced-by-count":68,"title":["Prognostic importance of the transmitral pressure gradient in mitral annular calcification with associated mitral valve dysfunction"],"prefix":"10.1093","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6324-6874","authenticated-orcid":false,"given":"Philippe B","family":"Bertrand","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School , 55 Fruit St Boston, MA 02114, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0215-3049","authenticated-orcid":false,"given":"Timothy W","family":"Churchill","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School , 55 Fruit St Boston, MA 02114, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7074-6380","authenticated-orcid":false,"given":"Evin","family":"Yucel","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School , 55 Fruit St Boston, MA 02114, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8985-3947","authenticated-orcid":false,"given":"Mayooran","family":"Namasivayam","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School , 55 Fruit St Boston, MA 02114, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9212-6721","authenticated-orcid":false,"given":"Samuel","family":"Bernard","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School , 55 Fruit St Boston, MA 02114, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5481-7524","authenticated-orcid":false,"given":"Yasufumi","family":"Nagata","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School , 55 Fruit St Boston, MA 02114, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8796-7147","authenticated-orcid":false,"given":"Wei","family":"He","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School , 55 Fruit St Boston, MA 02114, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl T","family":"Andrews","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School , 55 Fruit St Boston, MA 02114, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9264-3243","authenticated-orcid":false,"given":"Michael H","family":"Picard","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School , 55 Fruit St Boston, MA 02114, 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