Predictors of Very Late Events After Percutaneous Mitral Valvuloplasty in Patients With Mitral Stenosis

Jorge, Elisabete; Pan, Manuel; Baptista, Rui; Romero, Miguel; Ojeda, Soledad; Lezo, Javier Suárez de; Faria, Henrique; Calisto, João; Monteiro, Pedro; Pêgo, M.; Lezo, José Suárez de

doi:10.1016/j.amjcard.2016.03.051

Cited by 8 publications

(3 citation statements)

References 25 publications

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“…The safety and efficacy of percutaneous balloon mitral valvuloplasty (PBMV) and mitral valve surgery (MVS) have already been established. PBMV is a safe and well-tolerated intervention and is associated with short-term benefits [3]. The increasing burden to reduce health-related expenses makes it compulsory to provide an effective and safe yet economical intervention.…”

Section: Introductionmentioning

confidence: 99%

Survival analysis of patients with rheumatic MS after PBMV compared with MVS in a low-to-middle-income country

et al. 2019

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IntroductionRheumatic mitral stenosis continues to be prevalent in developing countries, notably in endemic areas. Over the last few decades, percutaneous balloon mitral valvuloplasty (PBMV) has been established as a lower-cost alternative treatment for mitral stenosis (MS) in low-to-middle-income countries. PBMV has also been suggested to be an effective and safe alternative treatment modality. This study aims to analyse the survival of rheumatic MS patients treated with PBMV compared with those treated with mitral valve surgery (MVS).MethodsThis study was a national, single-centre, longitudinal study using a survival analysis method in 329 consecutive patients suffering from rheumatic heart disease with severe MS who underwent PBMV compared with 142 consecutive patients with similar characteristics who underwent MVS between January 2011 and December 2016. Survival analysis and event-free duration were determined over a median follow-up of 24 months in the PBMV group and 27 months in the MVS group.ResultsThe results showed that of the 329 consecutive patients in the PBMV group, 61 patients (18.5) had an event (6 patients died and 55 patients were hospitalised), and of the 142 consecutive patients in the MVS group, 19 patients (13.4%) had an event (5 patients died, and 14 patients were hospitalised). The hazard ratio was 0.631 (95% confidence interval, 0.376–1.058; P = 0.081). Longer short-term survival was found in the MVS group but was not statistically significant. Event-free survival was significantly longer in the MVS group (P = 0.002), by 5 months.ConclusionsIn this study, the efficacy and safety of PBMV was reconfirmed, as PBMV proved to be non-inferior to MVS in survival prognosis, but sustained event-free duration was significantly better in the MVS group than in the PBMV group.

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Section: Introductionmentioning

confidence: 99%

Survival analysis of patients with rheumatic MS after PBMV compared with MVS in a low-to-middle-income country

et al. 2019

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“…Baseline PVR> 1.81 WU has been shown to be an independent predictor of persistent elevation of RVSP > 50 mmHg immediately after PBMV with 69% sensitivity and 86% specificity (95% confidence interval: 64-95; p = 0.002; AUC = 0.79) [35]. Furthermore, post-PBMV PAPm has been established as an independent predictor of all-cause mortality (per mmHg -HR: 1.045; 95% confidence interval: 1.015 -1.077; p = 0.003) and mitral valve reintervention (per mmHg -HR: 1.055; 95% confidence interval: 1.024 -1.087; p < 0.001) [36].…”

Section: Pulmonary Hypertension Due To Left Heart Disease (Ph-2)mentioning

confidence: 97%

Diagnostic and Predictive Value of Right Heart Catheterization-Derived Measurements in Pulmonary Hypertension

2021

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Right heart catheterization is a unique tool not only in the diagnosis but also in the management of patients with a wide range of cardiovascular diseases. The technique dates back to the 18th century, but the biggest advances were made in the 20th century. This review focuses on pulmonary hypertension for which right heart catheterization remains the diagnostic gold standard. Right heart catheterization-derived parameters help classify pulmonary hypertension into several subgroups, assess risk of adverse events or mortality and make therapeutic decisions. According to the European Society of Cardiology guidelines pulmonary hypertension (PH) is defined as an increase in mean pulmonary artery pressure (PAPm) > 25 mmHg, whereas a distinction between pre- and post-capillary PH is made based on levels of pulmonary artery wedge pressure (PAWP). Moreover, right atrial pressure (RAP), cardiac index (CI) and mixed venous oxygen saturation (SvO2) are the only parameters recommended to assess prognosis and only in patients with pulmonary arterial hypertension (PAH). Patients with RAP > 14 mmHg, CI < 2.0 l/min/m2 and SvO2 < 60% are at high (> 10%) risk of death within the next year. The purpose of this paper is to show that RHC-derived parameters can be used on a considerably larger scale than currently recommended. Several prognostic parameters, with specific thresholds have been identified for each subtype of pulmonary hypertension and can be helpful in everyday practice for treatment of PH.

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“…18 A study of 532 patients from 1987 to 2011 also showed that postoperative MVA was consistently identified as a predictor of restenosis and has a strong prognostic impact on event-free survival as components for optimal outcome. 19 A research conducted at Siriraj Hospital between 1996 and 2013 aimed to find predictor factors which related to long-term adverse outcome in isolated rheumatic mitral stenosis. This study analysed 185 subjects and found that LA diameter greater than 50 mm (HR 2.61, 95% CI: 1.08-6.30; p = 0.03) were associated with an effect long-term side such as death, hospitalization, new onset atrial fibrillation, and or embolic stroke.…”

Section: Post Et Al (mentioning

confidence: 99%

Risk Stratification and Mortality in Mitral Stenosis Patients

Maharani

Mumpuni

Hidayati

2021

Acta Cardiol Indones

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Background: Rheumatic mitral stenosis is the most common valvular abnormalities found in developing countries. Mortality risk in those populations was poorly investigated. In addition, hemodynamic, morphological, and mechanical factors that influence or predict outcome of rheumatic mitral stenosis have not been identified. Aims: To determine predictive factors affecting outcome in rheumatic mitral stenosis patients. Method: This retrospective cohort study was conducted at the National General Hospital Dr. Sardjito, Yogyakarta, Indonesia. The study recruited patients from the Valvular Heart Disease Registry from May 2014 to November 2020. New York Heart Association (NYHA) functional classification, invasive or surgical treatment, and incidence of death were recorded. The baseline rhythm from electrocardiography (ECG) was categorized as sinus rhythm and atrial fibrillation or atrial flutter. Based on the findings of trans thoracal echocardiography (TTE), subjects who had moderate to severe pure rheumatic mitral stenosis (or followed by mitral regurgitation and / or less significant tricuspid regurgitation as a natural history) and subjects with rheumatic mitral stenosis with a combination of other heart valve problems (of which severity more significantly) classified as groups I and II. The mitral valve area (MVA), mitral valve gradient (MVG), left atrial diameter (LA), and mean pulmonary artery pressure (mPAP) were then analyzed. Results: A total of 477 patients (mean age 44.08 ± 10.93 years; 71.5% female) were enrolled in this study. There were 61 deaths during the median follow up of 393 days of which 35 deaths occurred in group I and 26 deaths occurred in group II. Kaplan Meier curve shows the 1 year survival rate is higher in group I than group II which is 92.5% and 92%, respectively. Bivariate followed by multivariate analysis showed MVG and mPAP were predictive risk factors for mortality in group I with p = 0.020 and p = 0.021. MVG parameter values evaluated from echocardiography with a cut-off of more than 10 mmHg and mPAP parameters with a cut-off of more than 50 mmHg were independent predictive risk factors for mortality. Thus, patients were at higher risk of death if MVG > 10 mmHg and mPAP > 50 mmHg Conclusion: One year survival rate in group I was higher than group II. MVG and mPAP were risk factors for predicting mortality in group I.

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Predictors of Very Late Events After Percutaneous Mitral Valvuloplasty in Patients With Mitral Stenosis

Cited by 8 publications

References 25 publications

Survival analysis of patients with rheumatic MS after PBMV compared with MVS in a low-to-middle-income country

Survival analysis of patients with rheumatic MS after PBMV compared with MVS in a low-to-middle-income country

Diagnostic and Predictive Value of Right Heart Catheterization-Derived Measurements in Pulmonary Hypertension

Risk Stratification and Mortality in Mitral Stenosis Patients

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