Mechanisms of mitral annular calcification
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MAC is an incompletely understood disorder with important clinical and prognostic implications. It is associated with cardiovascular morbidity and mortality and adverse outcomes with cardiovascular procedures and surgeries. Its pathobiology has important differences in comparison with atherosclerosis and calcific aortic valve disease, mainly MAC's preponderance among women and those with dysregulated bone and mineral metabolism. With the aging of the population, MAC is assuming increasing importance, underscoring the need for in-depth understanding of this condition in order to enable the discovery of targeted therapies to reduce its associated adverse outcomes.

The mitral annulus is a fibrous structure that surrounds the mitral valve leaflets and is prone to calcification. Despite its common occurrence, association with cardiovascular morbidity and mortality and relationship with dysfunction of the mitral valve, the pathobiology of mitral annular calcification is incompletely understood.

Mitral annular calcification is no longer regarded as a local, chronic and degenerative process resulting in precipitation of calcium and phosphate, but as an active and regulated molecular process that is related to lipid metabolism, hemodynamic stress, chronic kidney disease, bone, and mineral metabolism and inflammation. This review summarizes the current evidence examining the pathophysiologic determinants of mitral annular calcification.

Source: https://www.sciencedirect.com/science/article/pii/S1050173819301033
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