Comparison of Clinical Characteristics, Natural History and Predictors of Disease Progression in Patients With Degenerative Mitral Stenosis Versus Rheumatic Mitral Stenosis

Kuyama, Naoto; Hamatani, Yasuhiro; Okada, Atsushi; Irie, Yuki; Nakai, Michikazu; Takahama, Hiroyuki; Yanagi, Yoshiki; Jo, Yoshito; Kanzaki, Hideaki; Yasuda, Satoshi; Tsujita, Kenichi; Izumi, Chisato

doi:10.1016/j.amjcard.2020.12.026

Cited by 4 publications

(8 citation statements)

References 24 publications

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“…(3) patients with CMS had a lower mean TMPG despite comparable 3D-TEE-derived-MVA, (4) more patients with RMS had dyspnea on exertion, and (5) independent determinants of dyspnea were pressure half time in the RMS group; MVA by 3D planimetry and estimated right atrial pressure in the DMS group; and left ventricular ejection fraction in the CMS group. There have been several reports on the comparison between RMS and DMS; however, to the best of our knowledge, there are few reports that compare clinical presentation and echocardiographic characteristics between CMS and another type of MS. 16,17 In the present study, the RMS group had the highest prevalence of dyspnea among the three groups, and the determinant of dyspnea in this group was pressure half time. RMS patients had the smallest effective orifice area using the continuity equation among patients with the three types of MS, thus, the hemodynamic severity of MS was worst.…”

Section: Discussionsupporting

confidence: 43%

“…In this retrospective study, we investigated differences in the clinical presentation and echocardiographic characteristics, including determinants of dyspnea on exertion, among three etiologies of MS. We found that: (1) patients with RMS were younger, (2) patients with DMS and those with CMS had more cardiovascular comorbidities, (3) patients with CMS had a lower mean TMPG despite comparable 3D‐TEE‐derived‐MVA, (4) more patients with RMS had dyspnea on exertion, and (5) independent determinants of dyspnea were pressure half time in the RMS group; MVA by 3D planimetry and estimated right atrial pressure in the DMS group; and left ventricular ejection fraction in the CMS group. There have been several reports on the comparison between RMS and DMS; however, to the best of our knowledge, there are few reports that compare clinical presentation and echocardiographic characteristics between CMS and another type of MS 16,17 …”

Section: Discussionmentioning

confidence: 99%

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Clinical and echocardiographic differences in three different etiologies of severe mitral stenosis

et al. 2022

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Background In our institute, the causes of mitral stenosis (MS) are generally categorized into three main etiologies—rheumatic MS (RMS), degenerative MS with annular and leaflet calcification, and post‐clip MS as a consequence of transcatheter mitral valve repair with clips for treating mitral regurgitation. However, clinical differences among the three etiologies are uncertain. Methods We retrospectively assessed 293 consecutive patients (53 with RMS, 118 with degenerative MS, and 122 with post‐clip MS) who had a three‐dimensional (3D) transesophageal echocardiography (TEE) derived mitral valve orifice area (MVA) of ≤1.5 cm2, and a mean transmitral pressure gradient of ≥5 mmHg on transthoracic echocardiography. Results Although there was no difference in 3D‐TEE‐derived MVA among the three groups, patients with post‐clip MS had a significantly lower mean transmitral pressure gradient compared to those with either of the other two types of MS (10.8 ([7.9–15.2] mmHg vs. 9.6 [7.3–12.5] mmHg vs. 6.9 [6.0–9.2] mmHg; p < .001). Patients with RMS had a higher prevalence of dyspnea. The independent determinants of dyspnea were pressure half time in RMS, 3D‐TEE‐derived MVA and estimated right atrial pressure in degenerative MS, and left ventricle ejection fraction in post‐clip MS. Conclusions Patients with post‐clip MS had the lowest mean transmitral pressure gradient, and patients with RMS had the highest prevalence of dyspnea, despite having a similar 3D‐TEE‐derived MVA. The determinants of dyspnea were different among the three etiologies of MS.

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Section: Discussionsupporting

confidence: 43%

Section: Discussionmentioning

confidence: 99%

Clinical and echocardiographic differences in three different etiologies of severe mitral stenosis

et al. 2022

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“… 24 , 25 Previous studies characterizing the natural history of rheumatic MS included a small number of patients (<100 patients) or a relatively short follow‐up duration (<5 years). 26 , 27 , 28 , 29 , 30 Moreover, most of these studies focused predominantly on changes in a few specific values, such as MVA or mean diastolic pressure gradient. 26 , 27 , 28 Although several studies have reported the association between PASP and postoperative prognosis in patients with MS, the literature on PASP in MS is scarce.…”

Section: Discussionmentioning

confidence: 99%

“… 26 , 27 , 28 , 29 , 30 Moreover, most of these studies focused predominantly on changes in a few specific values, such as MVA or mean diastolic pressure gradient. 26 , 27 , 28 Although several studies have reported the association between PASP and postoperative prognosis in patients with MS, the literature on PASP in MS is scarce. 9 , 31 Furthermore, there is a paucity of studies evaluating serial changes in PASP and their effects on MS progression and outcomes.…”

Section: Discussionmentioning

confidence: 99%

Identification of Distinct Subgroups in Moderately Severe Rheumatic Mitral Stenosis Using Data‐Driven Phenotyping of Longitudinal Hemodynamic Progression

Cho

Kim

et al. 2022

JAHA

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Background Rheumatic mitral stenosis is a significant cause of valvular heart disease. Pulmonary arterial systolic pressure (PASP) reflects the hemodynamic consequences of mitral stenosis and is used to determine treatment strategies. However, PASP progression and expected outcomes based on PASP changes in patients with moderately severe mitral stenosis remain unclear. Methods and Results A total of 436 patients with moderately severe rheumatic mitral stenosis (valve area 1.0–1.5 cm 2 ) were enrolled. Composite outcomes included all‐cause mortality and hospitalization for heart failure. Data‐driven phenotyping identified 2 distinct trajectory groups based on PASP progression: rapid (8.7%) and slow (91.3%). Patients in the rapid progression group were older and had more diabetes and atrial fibrillation than those in the slow progression group (all P <0.05). The initial mean diastolic pressure gradient and PASP were higher in the rapid progression group than in the slow progression group (6.2±2.4 mm Hg versus 5.1±2.0 mm Hg [ P =0.001] and 42.3±13.3 mm Hg versus 33.0±9.2 mm Hg [ P <0.001], respectively). The rapid progression group had a poorer event‐free survival rate than the slow progression group (log‐rank P <0.001). Rapid PASP progression was a significant risk factor for composite outcomes even after adjusting for comorbidities (hazard ratio, 3.08 [95% CI, 1.68–5.64]; P <0.001). Multivariate regression analysis revealed that PASP >40 mm Hg was independently associated with allocation to the rapid progression group (odds ratio, 4.95 [95% CI, 2.08–11.99]; P <0.001). Conclusions Rapid PASP progression was associated with a higher risk of the composite outcomes. The main independent predictor for rapid progression group allocation was initial PASP >40 mm Hg.

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“…28 However, more recent study from Japan did not show relationship between severity of MAC and mitral disease progression. 26 On the other hand, severity of DMS as assessed by mean pressure gradient was consistently associated with progression of MS. 24,26 Treatment of DMS is also challenging for both surgical and transcatheter approach. 30 Percutaneous mitral valvuloplasty is usually not indicated for DMS.…”

Section: Valvular Heart Disease and MCmentioning

confidence: 96%

Prevalence of mitral annular calcification and its association with mitral valvular disease

et al. 2021

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Background: Mitral annular calcification (MAC) is increasingly observed in elderly population. The purpose of this study was to investigate incidence of MAC and its association with mitral valvular disease (MVD).Methods: A total of 13,483 consecutive patients who underwent echocardiography were enrolled. MAC was defined as an echo-dense, shelf-like structure with an irregular, lumpy appearance involving the mitral valve annulus, with acoustic shadowing.Prevalence of MAC and its association with significant mitral stenosis (MS) or mitral regurgitation (MR) were studied. Significant (≥moderate) MS was defined as mean transmitral valvular pressure gradient > 5 mm Hg and significant MR was defined as ≥moderate MR based on quantitative or semi-quantitative Doppler methods.Results: MAC was present in 1881 of 13,483 patients (14%). Patients with MAC (MAC group) was older and more female gender than those without MAC (non-MAC group). Significant MS was present in 2.2% of MAC and in .6% of the non-MAC group (p < 0.0001). Significant MR was present in 11.9% of MAC and in 5.0% of the non-MAC group (p < 0.0001). Co-existence of MAC and aortic valve replacement (AVR) was associated with increased prevalence of MVD (MS:11.4%, MR:17.2%, respectively). Conclusion:MAC was present in 14% of the patients and was associated with significant MVD. Co-existence of MAC and AVR may increase the risk of MVD.

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Comparison of Clinical Characteristics, Natural History and Predictors of Disease Progression in Patients With Degenerative Mitral Stenosis Versus Rheumatic Mitral Stenosis

Cited by 4 publications

References 24 publications

Clinical and echocardiographic differences in three different etiologies of severe mitral stenosis

Clinical and echocardiographic differences in three different etiologies of severe mitral stenosis

Identification of Distinct Subgroups in Moderately Severe Rheumatic Mitral Stenosis Using Data‐Driven Phenotyping of Longitudinal Hemodynamic Progression

Prevalence of mitral annular calcification and its association with mitral valvular disease

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