{"id":"d565bcd1a593","type":"article","url":"https://hartvaat.nl/2026/02/02/jamac-studie-slechte-5-jaarsprognose-bij-mitralisstenose-door-mitralisringverkal/","title":"JAMAC-studie: slechte 5-jaarsprognose bij mitralisstenose door mitralisringverkalking","title_en":"Mitral Annular Calcification-Related Mitral Stenosis: 5-Year Outcomes and Prognostic Determinants in the JAMAC Study","category":"chronische nierziekte","category_label":"Nierziekte","professions":["cardioloog"],"tags":["mitralisstenose"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2025.12.004","source_url":"https://doi.org/10.1016/j.jacc.2025.12.004","authors":["Nahoko Kato","Takatomo Watanabe","Takuma Ishihara","Nobuyuki Kagiyama","Maika Shimizu","Yukio Abe","Yoshiki Matsumura","Tetsuari Onishi","Yasushi Ichikawa","Koki Nakanishi","Yasuki Nakada","Nozomi Fukuda","Chisato Izumi","Shinichi Kurashima","Yoshihiro Seo","Shohei Kikuchi","Nozomi Watanabe","Keiko Nagatomo","Yuki Izumi","Ayumi Nakabo","Masao Daimon","Hiroyuki Watanabe","Hiroyuki Okura"],"significance":7,"published":"2026-02-02","source_date":"2026-02-02","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/nierziekte/contrastmiddel-en-nierfunctie/"],"congress":"","summary_en":"Mitral stenosis from mitral annular calcification (MAC) occurs mainly in older patients and is associated with increased mortality, but reliable long-term data were lacking. The retrospective, multicentre JAMAC study (264 patients from 11 Japanese centres, median age 78, 73% female) examined 5-year outcomes: 76% had calcific and 24% rheumatic mitral stenosis. Median mitral valve area (MVA) was 1.40 cm² and mean transmitral gradient 6.1 mmHg. Five-year survival was only 57%, with more non-cardiac (24%) than cardiac (16%) death; calcific stenosis had higher mortality than rheumatic. Anterior and severe posterior MAC, and MVA <1.5 cm², predicted mortality; on multivariable analysis MVA remained independently associated with death (adjusted HR 1.56), alongside age and chronic kidney disease. The prognosis of MAC-related mitral stenosis is thus poor, driven mainly by non-cardiac mortality.","created":"2026-07-03T10:32:20Z","updated":"2026-07-03T13:31:17Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Mitralisstenose door mitralisringverkalking (mitral annular calcification, MAC) komt vooral voor bij oudere patiënten en gaat gepaard met verhoogde sterfte, maar betrouwbare langetermijngegevens ontbraken. De retrospectieve, multicentrische JAMAC-studie (264 patiënten uit 11 Japanse centra, mediane leeftijd 78 jaar, 73% vrouw) onderzocht de 5-jaarsuitkomsten: 76% had calcifische en 24% reumatische mitralisstenose. De mediane mitralisklepoppervlakte (MVA) was 1,40 cm² en de gemiddelde transmitrale gradiënt 6,1 mmHg. De 5-jaarsoverleving was slechts 57%, met meer niet-cardiale (24%) dan cardiale sterfte (16%); calcifische stenose had een hogere sterfte dan reumatische. Anterieure en ernstige posterieure MAC en een MVA <1,5 cm² voorspelden sterfte; in multivariabele analyse bleef de MVA onafhankelijk geassocieerd met overlijden (gecorrigeerde HR 1,56), naast leeftijd en chronische nierziekte. De prognose van MAC-gerelateerde mitralisstenose is dus slecht en wordt vooral bepaald door niet-cardiale sterfte.","abstract_original":"BACKGROUND: Mitral annular calcification (MAC)-related mitral stenosis is associated with increased mortality, but robust long-term outcomes remain unclear. OBJECTIVES: The aim of this study was to investigate 5-year outcomes, including causes of death and valve-related prognostic factors, in patients with MAC-related mitral stenosis. METHODS: The retrospective, multicenter JAMAC (Japan Multicenter Mitral Annular Calcification) study included adult patients from 11 Japanese centers who underwent echocardiography between 2016 and 2017 and had MAC with a transmitral mean gradient ≥5 mm Hg. Mitral stenosis etiology, mitral valve area (MVA), and anterior MAC in the parasternal long-axis view were evaluated. Posterior MAC was graded as mild (less than one-third), moderate (one-third to two-thirds), or severe (more than two-thirds) of the posterior mitral annular circumference in the parasternal short-axis view. The primary outcome was all-cause mortality; secondary outcomes were cardiac and noncardiac death. To determine valve-related prognostic factors, multivariable analysis was performed including key clinical variables. RESULTS: Among 264 patients (median age 78 years; 73% female), 201 (76%) had calcific mitral stenosis and 63 (24%) had rheumatic mitral stenosis. Median MVA was 1.40 cm2, transmitral mean gradient was 6.1 mm Hg, and 63% had anterior MAC. Posterior MAC was severe in 47% and moderate in 25%. Five-year survival was 57%; cardiac and noncardiac mortality was 16% and 24%, respectively. Calcific mitral stenosis showed higher mortality compared with rheumatic mitral stenosis (cardiac death: 18% vs 11%; noncardiac death: 28% vs 13%). Anterior and severe posterior MAC were associated with increased mortality. MVA <1.5 cm2 predicted mortality in calcific mitral stenosis. On multivariable analysis, MVA remained associated with mortality (adjusted HR: 1.56; 95% CI: 1.03-2.38), independent of age and chronic kidney disease, both strong predictors of death. CONCLUSIONS: The prognosis of MAC-related mitral stenosis was poor, with a 5-year survival of 57%, mainly driven by noncardiac mortality in calcific mitral stenosis. Severity of mitral stenosis was one of the independent predictors in this high-risk population."}