# Ernstige mitralisklepringscalcificatie correleert met invasief bewijs van HFpEF

*geplaatst 2026-10-05 · Hartfalen · Medicine · doi 10.1097/MD.0000000000050835 · https://hartvaat.nl/2026/09/25/ernstige-mitralisklepringscalcificatie-correleert-met-invasief-bewijs-van-hfpef/*

Een enkelcentrale studie bij 160 patiënten met een vermoeden van HFpEF toont aan dat de ernst van mitralisklepringscalcificatie (MAC) lineair toeneemt met de invasief gemeten pulmonale capillaire wigdrukdruk en de kans op een bevestigde HFpEF-diagnose. Patiënten met MAC-gradatie 4 hadden een 85% kans op invasief bewijs van HFpEF, vergeleken met 28% bij gradatie 1 (OR 1,78 per categorie; P = 0,03). Deze bevinding bevestigt dat gevorderde MAC een sterk beeldvormend kenmerk is van de diastolische belasting bij HFpEF, wat kan helpen bij het stratificeren van patiënten voor verdere hemodynamische evaluatie.

## English: Mitral annular calcification severity and invasive hemodynamic confirmation of HFpEF: A prospective observational study.

In a single-center study of 160 patients referred for HFpEF assessment, increasing severity of mitral annular calcification (MAC) showed a graded association with invasively measured pulmonary capillary wedge pressure and the likelihood of meeting invasive HFpEF criteria. The proportion of patients with confirmed HFpEF rose from 28.1% in MAC grade 1 to 85.0% in grade 4 (OR 1.78 per grade increase; P = 0.03). These findings reinforce that advanced MAC is a strong imaging marker of diastolic burden and may aid in risk stratification for invasive hemodynamic testing in suspected HFpEF.

## Abstract (original, from the publication)

Mitral annular calcification (MAC) is a common degenerative process in older adults that can impair mitral valve compliance, elevate transmitral gradients, and increase left ventricular filling pressure. However, the extent to which increasing MAC severity parallels invasive hemodynamic evidence of heart failure with preserved ejection fraction (HFpEF) and established diagnostic algorithms remains uncertain. This was a single-center cross-sectional study. We evaluated 160 patients referred for HFpEF assessment who underwent comprehensive echocardiography. MAC severity was graded from 1 to 4 (n = 40 per group). HFpEF was defined invasively as a pulmonary capillary wedge pressure of ≥15 mm Hg at rest or ≥18 mm Hg after a standardized fluid challenge. Multivariable regression models tested the independent association between MAC grade (per 1-category increase) and invasive HFpEF diagnosis, as well as continuous H2FPEF (Heavy, Hypertensive, Atrial fibrillation, Pulmonary hypertension, Elder, Filling pressure score) and HFA-PEFF (Heart Failure Association Pretest Assessment, Echocardiography and Natriuretic Peptide, Functional Testing, Final Etiology) scores, adjusting for natriuretic peptide levels and key echocardiographic diastolic parameters. Participants were older (mean age, 76 years) and two-thirds were female, with preserved left ventricular ejection fraction (~59%). Higher MAC severity was associated with progressive elevations in pulmonary capillary wedge pressure (13.0-18.0 mm Hg at rest; 16.0-24.5 mm Hg after fluid challenge; P < .001) and, among catheterized participants, with a higher proportion meeting invasive HFpEF criteria (28.1%, 30.0%, 60.0%, and 85.0% across grades 1-4, respectively; P < .001). MAC grade was independently associated with invasively defined HFpEF (odds ratio, 1.78; 95% confidence interval, 1.22-2.38; P = .03), H2FPEF (β, 0.31; P = .03), and HFA-PEFF (β, 0.42; P = .004) scores. N-terminal pro-B-type natriuretic peptide was correlated with all outcomes. MAC severity showed a graded relationship with diastolic burden, invasive HFpEF confirmation, and diagnostic scores, suggesting that advanced MAC is associated with a hemodynamic profile consistent with HFpEF.

Auteurs: Gizem Cabuk, Burcu Uludag Artun

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Bron: Medicine, https://doi.org/10.1097/MD.0000000000050835. Bijgewerkt 2026-09-28T01:25:52Z. 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.