부산대학교 도서관

Introduction:Clinical progression of rheumatic mitral stenosis (MS) typically spans several decades. It is characterized by progressive narrowing of the mitral orifice, with eventual hemodynamic deterioration. Although mitral valve (MV) intervention has changed the natural course of this disease, MS remains a progressive disease. This study aimed to assess the predictors of clinical outcome in a contemporary cohort of patients with MS on optimized guideline based therapy.Methods:A total of 590 patients with MS (valve area of 1.1 ? 0.4, range, 0.3 to 2.9 cm2), were prospectively enrolled between 2011 and 2019. The patients were divided into two groups according to MS severity. Group 1 comprised 321 patients with symptomatic severe MS who underwent percutaneous mitral valvuloplasty (PMV) at the time of enrollment, whereas group 2 included 269 with progressive or asymptomatic MS, without initial indication for valve intervention. The patients were followed for a mean of 3 years. The endpoint was a composite of cardiovascular death or MV intervention.Results:The mean age was 46 ? 12 years, and 499 were women (85%). In group 1, the endpoint was reached in 72 patients, with an incidence of 6.2 events per 100 patient-years (pt/y). The predictors of events were NYHA class pre procedure (HR 1.87, 95% CI 1.317-2.65), and postprocedural MV area (HR 0.13, 95% CI 0.04-0.38), mean gradient (HR 1.12, 95% CI 1.12-1.57), and degree of mitral regurgitation (MR; HR 3.13 95% CI 1.92-5.09). In group 2, 37 events occurred with an incidence of 5.5 events per 100 pt/y, similar to group 1. The predictors of events were age (HR 1.03 95% CI 1.01-1.05), NYHA class (HR 1.53, 95% CI 1.17-2.01), degree of MR (HR 2.99 95% CI 1.52-5.89) and tricuspid regurgitation (TR; HR 2.15 95% CI 1.31-3.53), and interaction between MV area and net atrioventricular compliance (Cn).Conclusions:In this large cohort representative of a wide spectrum of disease severity, the predictors of outcome depended on the stages of MS. In patients with progressive MS, the baseline variables including functional status, MR and TR severity, MV area and Cnwere predictors of adverse outcome. Conversely, in the patients with severe MS who required intervention, postprocedural parameters were the main determinants of prognosis.