Abstract Body (Do not enter title and authors here): Background:
Mitral annular calcification (MAC) may be a marker of biological age; its impact on outcomes in patients with heart failure with preserved ejection fraction remains unclear.

Methods:
A retrospective propensity-matched cohort analysis of patients ages > 18 years hospitalized with diastolic heart failure with and without MAC in the TriNetX database. Cohorts were balanced on socio-demographics, and medications (anticoagulants, antiplatelet, beta-blockers, diuretics, anti-arrhythmic, lipid-lowering agents, and SGLT2i). Patients with rheumatic valve disease were excluded. Adjusted odds ratios (aOR) were calculated for outcomes and Kaplan-Meier survival analysis curves with log-rank tests over five-year follow-up were analyzed using R software.

Results:
There were 11384 participants matched to each cohort; the average age at diagnosis was 72.5 + 11.6 years, 76.2% were Caucasian, and 56.9% were female. Left ventricular ejection fractions were similar in both MAC (58.3 + 11.9) vs non-MAC (58.2 + 12.6). Median follow-up was 423 days (MAC group) and 575 days (non-MAC group). All-cause hospitalization (HR: 2.31, 95%CI: 2.04 – 2.62, p<0.001), heart failure hospitalization (HR: 2.22, 95%CI: 1.92 – 2.55, p<0.001), acute myocardial infarction (HR: 2.06, 95%CI: 1.79 – 2.35, p<0.001), unstable angina (HR: 2.28, 95%CI: 1.72-3.04, p<0.001), and stroke (HR: 1.70, 95%CI: 1.45 – 2.00, p<0.001) were all higher in MAC patients than non-MAC patients (table 1).

Conclusion: Among patients hospitalized with ‘diastolic heart failure’ MAC is associated with worse cardiovascular outcomes.