https://doi.org/10.4081/monaldi.2024.2941
20-year follow-up of rheumatic mitral stenosis patients after percutaneous mitral commissurotomy: invasive transmitral gradient differential as a predictor of events
Submitted: February 7, 2024
Accepted: February 23, 2024
Published: March 11, 2024
Accepted: February 23, 2024
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Percutaneous mitral valve commissurotomy (PMC) is a viable alternative to mitral valve (MV) surgery in the treatment of patients with rheumatic mitral stenosis (RMS). In this single-center retrospective study of consecutive patients with RMS submitted to PMC from 1991 to 2008, we analyzed clinical, echocardiographic, and hemodynamic data and events during follow-up (FUP) until December 2021. Major adverse cardiovascular events (MACE) were a combined endpoint of all-cause death, cardiovascular hospitalization, and MV re-intervention. A total of 124 patients were enrolled: 108 (87.1%) were female, with a mean age at PMC of 46 [standard deviation (SD) 11] years. PMC was successful in 91.1%, with a mean reduction in invasive transmitral pressure gradient (TMPG) of 8 (SD 7) mmHg at PMC time. During the mean FUP of 20 (SD 6) years, 51 (41.1%) patients had MV re-intervention (86.3% surgery and 13.7% redo-PMC), 37 (29.8%) were hospitalized, and 30 (24.2%) died. Approximately 75% of patients remained MACE-free after 10 years, and this percentage decreased to around 40% after 20 years; at this time mark, about 8 in 10 patients were alive. A reduction of <5 mmHg in TMPG at PMC time was associated with a 2.7-fold greater rate of MACE compared to a reduction of ≥5 mmHg, independent of MV regurgitation after PMC and moderate disease of other valves (adjusted hazard ratio 2,7; 95% confidence interval 1.395-5.298, p=0.003). In this cohort with favorable long-term results after PMC, a reduction of <5 mmHg in TMPG at PMC time was associated with MACE during FUP. More studies are needed to validate this independent predictor.
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Ethics Approval
The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki. Observational studies are not mandatory to be proposed to the local ethical committee.How to Cite
Amador, Ana Filipa, Catarina Costa, Ricardo Pinto, Miguel Carvalho, Tânia Proença, João Calvão, Sandra Amorim, Mariana Paiva, João Carlos Silva, and Rui Rodrigues. 2024. “20-Year Follow-up of Rheumatic Mitral Stenosis Patients After Percutaneous Mitral Commissurotomy: Invasive Transmitral Gradient Differential As a Predictor of Events”. Monaldi Archives for Chest Disease, March. https://doi.org/10.4081/monaldi.2024.2941.
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