Assessment of left atrial volume and mechanical functions using real-time three-dimensional echocardiography in patients with mitral annular calcification

Objective: Mitral annular calcification (MAC) is degeneration of the fibrous annular ring of the mitral valve. Left atrial (LA) function and volume have been evaluated by many methods; however, none have used real-time three-dimensional echocardiography (RT3DE) in patients with MAC. Our study is the first to evaluate LA volume and mechanical function using RT3DE in patients with MAC. Methods: Our study was a prospective cross-sectional study. In total, 32 patients with echocardiographic evidence of MAC and 30 volunteers without MAC were enrolled in the study. Kolmogorov-Smirnov test, Student's t-test, Mann-Whitney U test, chi-square test, Pearson's correlation test, and multiple linear regression analyses were used in this study. Results: LA diameter was significantly higher in patients with MAC (38.5 +/- 3.8 vs. 31.1 +/- 2.9, p<0.001). Maximum LA volume (49.6 +/- 11.2 vs. 35.6 +/- 2.5, p<0.001), minimum LA volume (23.8 +/- 7.9 vs. 12.6 +/- 2.3, p<0.001), and LA volume index (LAVI) (26.9 +/- 6.1 vs. 20.5 +/- 2.4, p<0.001) were also higher in the MAC group. LAVI was correlated with age (p<0.001), blood urea nitrogen levels (p=0.089), total cholesterol levels (p=0.055), left ventricular systolic myocardial velocity (p=0.048), E/A ratio (p<0.001), and MAC (p<0.001). Multiple linear regression analyses revealed that age (beta=0.390, p<0.001) and MAC (beta=0.527, p<0.001) were independent predictors of LAVI. Conclusion: We found that LA mechanical function was impaired in patients with MAC. Furthermore, age and MAC were independent predictors of increased LAVI according to our RT3DE examination.