Thrombus on Mitral Annular Calcification: A Systematic Review of Management and Outcomes
Bibliographic record
Abstract
Background: Mitral annular calcification (MAC) is a common chronic degenerative process of the mitral valve. Thrombus formation on MAC is a rare complication that likely contributes to the increased risk of thromboembolic events. Outcomes and management strategies for this condition are unknown. The aim of this study was to perform a systematic review to describe the management and outcomes of patients who have thrombus on MAC. Methods: The MEDLINE, Embase, and Cochrane databases were searched. Patients with a prior mitral valve intervention or prosthesis were excluded. The primary outcomes were treatment, mortality, and thromboembolic events. Results: Fifteen studies, with a total of 22 cases (patients aged 69.1 ± 14.8 years; n = 18 [82%] female) were included. Most patients presented with stroke or a transient ischemic event (n = 15; 68%) or myocardial infarction (n = 4; 18%). All patients were diagnosed with either transthoracic (n = 18; 82%) or transesophageal (n = 4; 18%) echocardiography. Seventeen patients (77%) were treated with anticoagulation therapy alone, and 5 (23%) required surgery. The most common surgical indication was prevention of recurrent embolization (n = 3; 14%). No mortality was reported. Six patients (27%) had thromboembolic events after diagnosis. For those treated with anticoagulation therapy alone, 5 (23%) had persistent thrombus with or without embolization. Conclusions: In this systematic review, patients with MAC who present with a thromboembolic event require careful echocardiographic assessment of the MAC, to exclude the presence of thrombus. Although most patients can be managed with anticoagulation therapy alone, a significant number will require surgery. Persistent thrombus, despite anticoagulation therapy, and recurrent embolization are common. Larger studies are needed to elucidate what constitutes the optimal long-term care for these patients.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.004 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".