# JAMAC-studie: slechte 5-jaarsprognose bij mitralisstenose door mitralisringverkalking *geplaatst 2026-02-02 · Nierziekte · Journal of the American College of Cardiology · doi 10.1016/j.jacc.2025.12.004 · https://hartvaat.nl/2026/02/02/jamac-studie-slechte-5-jaarsprognose-bij-mitralisstenose-door-mitralisringverkal/* 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. ## English: Mitral Annular Calcification-Related Mitral Stenosis: 5-Year Outcomes and Prognostic Determinants in the JAMAC Study 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. ## Abstract (original, from the publication) 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. Auteurs: 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 --- Bron: Journal of the American College of Cardiology, https://doi.org/10.1016/j.jacc.2025.12.004. Bijgewerkt 2026-07-03T13:31:17Z. 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.