Optimizing Percutaneous Mitral Valvuloplasty for Rheumatic Mitral Stenosis Clinical Significance of Changes in Mitral Valve Area

초록

Background: Percutaneous mitral valvuloplasty (PMV) is a standard treatment for severe rheumatic mitral stenosis (RMS). However, the prognostic significance of the change in mitral valve area (OMVA) during PMV is not fully understood. Methods and Results: This study analyzed data from the Multicenter mitrAl STEnosis with Rheumatic etiology (MASTER) registry, which included 3,140 patients with severe RMS. We focused on patients with severe RMS undergoing their first PMV. Changes in echocardiographic parameters, including MVA quantified before and after PMV, and composite outcomes, including mitral valve reintervention, heart failure admission, stroke, and all-cause death, were evaluated. An optimal result was defined as a postprocedural MVA >= 1.5 cm2 without mitral regurgitation greater than Grade II. Of the 308 patients included in the study, those with optimal results and OMVA >0.5cm2 had a better prognosis (log-rank P<0.001). Patients who achieved optimal results but with OMVA <= 0.5cm2 had a greater risk of composite outcomes than those with optimal outcomes and O MVA >0.5cm2 (nested Cox regression analysis, hazard ratio 2.27; 95% confidence interval 1.09-4.73; P=0.028). Conclusions: Achieving an increase in OMVA of >0.5cm2 was found to be correlated with improved outcomes. This suggests that, in addition to achieving traditional optimal results, targeting an increase in O MVA of >0.5cm2 could be a beneficial objective in PMV treatment for RMS.

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