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Leow R, Li TYW, Kong WKF, Poh KK, Kuntjoro I, Sia CH, Yeo TC. Validation of Yeo's index in assessing severity of rheumatic mitral stenosis in mixed valve lesions. INTERNATIONAL JOURNAL OF CARDIOLOGY. HEART & VASCULATURE 2024; 53:101447. [PMID: 38979528 PMCID: PMC11228633 DOI: 10.1016/j.ijcha.2024.101447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/09/2024] [Accepted: 06/12/2024] [Indexed: 07/10/2024]
Abstract
Introduction Yeo's Index, product of the mitral leaflet separation index and dimensionless index, is a novel measure of the severity of rheumatic mitral stenosis (MS). We assess Yeo's index in patients with rheumatic MS with or without mixed valve disease. Methods In a retrospective cohort study, Yeo's index was measured in 237 cases of rheumatic MS - 124 in a transthoracic echocardiography validation cohort using mitral valve area (MVA) by pressure half-time and planimetry as comparator and 113 in a transesophageal echocardiography (TEE) validation cohort using TEE three-dimensional MVA as comparator. Patients were considered to have mixed valve disease if they had MS and concomitant mitral regurgitation or aortic valve disease. Results There were 113 patients with isolated MS and 124 patients with mixed valve disease. Overall, Yeo's index ≤ 0.26 cm showed 93.0 % sensitivity and 87.5 % specificity for identifying severe MS (MVA ≤ 1.5 cm2). In isolated MS, Yeo's index ≤ 0.26 cm showed sensitivity of 94.6 % and specificity of 90.0 % for identifying severe MS, while in mixed valve disease sensitivity was 90.6 % and specificity 86.7 %. Overall, Yeo's index ≤ 0.15 cm showed 83.6 % sensitivity and 94.3 % specificity for very severe MS (MVA ≤ 1.0 cm2). In isolated MS, the threshold of ≤0.15 cm showed sensitivity of 84.4 % and specificity of 92.6 % for very severe MS, while in mixed valve disease sensitivity was 81.3 % and specificity 95.3 %. The presence of atrial fibrillation did not influence the performance of Yeo's index. Conclusion Yeo's Index accurately differentiates severity of rheumatic MS with or without mixed valve disease.
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Affiliation(s)
- Ryan Leow
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Tony Yi-Wei Li
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - William K F Kong
- Department of Cardiology, National University Heart Centre Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kian-Keong Poh
- Department of Cardiology, National University Heart Centre Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ivandito Kuntjoro
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tiong-Cheng Yeo
- Department of Cardiology, National University Heart Centre Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Li T, Leow R, Chan MW, Kong WKF, Kuntjoro I, Poh KK, Sia CH, Yeo TC. Combining 2D Planimetry and Yeo's Index Can Help Accurately Identify Patients with Severe Rheumatic Mitral Stenosis-A Perspective from a 3D Assessment Using Transoesophageal Echocardiography. Diagnostics (Basel) 2024; 14:1440. [PMID: 39001329 PMCID: PMC11240934 DOI: 10.3390/diagnostics14131440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/24/2024] [Accepted: 07/03/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Yeo's index is a novel measure of the severity of rheumatic mitral valve stenosis (MS). It is derived from the product of the mitral leaflet separation index and dimensionless index. This study aims to validate Yeo's index using a transesophageal echocardiogram (TEE) three-dimensional (3D) mitral valve area (MVA) as a comparator and to compare the concordance of existing echocardiographic measures of the MVA with TEE 3DMVA. METHODS AND RESULTS We studied 111 patients with rheumatic MS who underwent both transthoracic echocardiography (TTE) and a TEE assessment of MS severity. Yeo's index, the MVA determined by 2D planimetry, pressure half-time (PHT) and continuity equation (CE) measured on TTE were compared with the TEE 3DMVA. With a linear correlation, Yeo's index showed the best correlation with TEE 3DMVA (r2 = 0.775), followed by 2D planimetry (r2 = 0.687), CE (r2 = 0.598) and PHT (r2 = 0.363). Using TEE 3DMVA as comparator, Yeo's index (ρc = 0.739) demonstrated the best concordance, followed by 2D planimetry (ρc = 0.632), CE (ρc = 0.464) and PHT (ρc = 0.366). When both Yeo's index and 2D planimetry suggested significant MS, the positive predictive value was high (an AUC of 0.966 and a PPV of 100.00% for severe MS, and an AUC of 0.864 and a PPV of 85.71% for very severe MS). When both measures suggested the absence of significant MS, the negative predictive value was also high (an AUC of 0.940 and an NPV of 88.90% for severe MS, and an AUC of 0.831 and an NPV of 88.71% for very severe MS). CONCLUSIONS Yeo's index performed well in identifying severe MS when compared with TEE 3DMVA and may be a useful adjunct to existing methods of measuring MS severity. Combining it with 2D planimetry could further enhance its accuracy.
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Affiliation(s)
- Tony Li
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119228, Singapore
| | - Ryan Leow
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119228, Singapore
| | - Meei Wah Chan
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119228, Singapore
| | - William K F Kong
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119228, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Ivandito Kuntjoro
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119228, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Kian Keong Poh
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119228, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Ching Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119228, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Tiong Cheng Yeo
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119228, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
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Abdelghani M, Nunes MCP, Anwar AM, Prendergast B. Assessment of suitability for percutaneous mitral commissurotomy: a contemporary review of key anatomical criteria and predictive models. Eur Heart J Cardiovasc Imaging 2024; 25:739-753. [PMID: 38376989 DOI: 10.1093/ehjci/jeae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/31/2024] [Accepted: 02/18/2024] [Indexed: 02/22/2024] Open
Abstract
The immediate result of percutaneous balloon mitral commissurotomy is largely determined by the anatomy of the mitral valve complex. Several scores and models have been developed to assess anatomical suitability for percutaneous balloon mitral commissurotomy. Although none has an optimal predictive power, these models look at the valvular apparatus from different perspectives bearing the potential for a complementary role.
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Affiliation(s)
- Mohammad Abdelghani
- Cardiology Department, Al-Azhar University, Nasr City, 11651 Cairo, Egypt
- Cardiology Unit, Sohar Hospital, Muwelleh Street, 311 Sohar, Oman
- Cardiology Department, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Maria Carmo P Nunes
- Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ashraf M Anwar
- Cardiology Department, Al-Azhar University, Nasr City, 11651 Cairo, Egypt
- Department of Cardiology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Bernard Prendergast
- Department of Cardiology, Guys and St Thomas' NHS Foundation Trust Hospital London, London, UK
- Heart, Vascular & Thoracic Institute, Cleveland Clinic London, London, UK
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Lee HJ, Cho I, Kim DY, Son JW, Choi KU, Lee S, Kim IC, Ko KY, Ha KE, Gwak SY, Kim K, Seo J, Kim H, Shim CY, Ha JW, Kim H, Hong GR, Narula J. Shifts in Clinical Characteristics, Treatment, and Outcome for Rheumatic Mitral Stenosis: Insights From a 20-Year Multicentre Registry Study in Korea. J Korean Med Sci 2024; 39:e152. [PMID: 38711317 PMCID: PMC11074495 DOI: 10.3346/jkms.2024.39.e152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/08/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND The rapid economic development of South Korea provides a unique model to study changes in the clinical characteristics, treatment approaches, and clinical outcomes of patients with rheumatic mitral stenosis (MS) relative to socioeconomic growth. METHODS From the Multicenter mitrAl STEnosis with Rheumatic etiology (MASTER) registry, 2,337 patients diagnosed with moderate or severe rheumatic MS between January 2001 and December 2020 were analyzed. Patients were grouped into consecutive 5-year intervals based on their year of diagnosis. Clinical characteristics, echocardiographic data, and clinical outcomes were assessed. RESULTS Over 20 years, the severity of mitral stenosis increased from 79.1% to 90.2%; similarly, the average age at diagnosis increased from 54.3 to 63.0 years (all P < 0.001). Comorbidities such as hypertension and atrial fibrillation increased (6.3% to 29.5% and 41.4% to 46.9%, respectively; all P for trend < 0.05). The rate of mitral intervention within five years after diagnosis increased from 31.2% to 47.4% (P for trend < 0.001). However, clinical outcomes of rheumatic mitral stenosis deteriorated over time in the composite outcomes (log-rank test, P < 0.001). Conversely, the incidence of stroke remained stable (60.6-73.7%; P < 0.001), which might be attributed to the increased use of anticoagulation therapy. CONCLUSION This study observed an increase in patient age, comorbidities, and valve disease severity as the country transitioned from a developing to developed status. Despite a rise in mitral valve interventions, clinical outcomes deteriorated over 20 years, highlighting the need for modified treatment approaches to improve patient outcomes.
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Affiliation(s)
- Hee Jeong Lee
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Iksung Cho
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dae-Young Kim
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Jang-Won Son
- Division of Cardiology, Yeungnam University Medical Center, Daegu, Korea
| | - Kang-Un Choi
- Division of Cardiology, Yeungnam University Medical Center, Daegu, Korea
| | - Seonhwa Lee
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - In-Cheol Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Kyu-Yong Ko
- Division of Cardiology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Kyung Eun Ha
- Division of Cardiology, Gachon University Gil Medical Center, Incheon, Korea
| | - Seo-Yeon Gwak
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jiwon Seo
- Department of Internal Medicine, Yonsei University Gangnam Severance Hospital, Seoul, Korea
| | - Hojeong Kim
- Division of Physiology, Department of Biomedical Laboratory, Daegu Health College, Daegu, Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong-Won Ha
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyungseop Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Geu-Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Wild MG, Bothe W, Westermann D, Czerny M, Besler C. [Catheter-based and surgical treatment of mitral valve diseases]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2024; 65:439-446. [PMID: 38597993 DOI: 10.1007/s00108-024-01703-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/11/2024]
Abstract
There is a broad spectrum of mitral valve diseases ranging from young patients with rheumatic mitral valve stenosis up to older patients with secondary mitral valve regurgitation and numerous comorbidities. A profound understanding of the etiology, anatomical characteristics of mitral valve diseases and current treatment options is necessary to be able to prepare a patient-centered treatment approach. The interdisciplinary collaboration of referring physicians, interventional cardiologists, cardiac surgeons, heart failure and imaging specialists as well as anesthesiologists is a cornerstone of optimal patient treatment.
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Affiliation(s)
- Mirjam G Wild
- Klinik für Kardiologie und Angiologie, Universitäts-Herzzentrum Freiburg/Bad Krozingen, Universitätsklinikum Freiburg, Südring 15, 79189, Bad Krozingen, Deutschland
| | - Wolfgang Bothe
- Klinik für Herz- und Gefäßchirurgie, Universitäts-Herzzentrum Freiburg/Bad Krozingen, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Dirk Westermann
- Klinik für Kardiologie und Angiologie, Universitäts-Herzzentrum Freiburg/Bad Krozingen, Universitätsklinikum Freiburg, Südring 15, 79189, Bad Krozingen, Deutschland
| | - Martin Czerny
- Klinik für Herz- und Gefäßchirurgie, Universitäts-Herzzentrum Freiburg/Bad Krozingen, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Christian Besler
- Klinik für Kardiologie und Angiologie, Universitäts-Herzzentrum Freiburg/Bad Krozingen, Universitätsklinikum Freiburg, Südring 15, 79189, Bad Krozingen, Deutschland.
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Kim DY, Cho I, Kim K, Gwak SY, Ha KE, Lee HJ, Ko KY, Shim CY, Ha JW, Kim WD, Kim IJ, Lee S, Kim IC, Choi KU, Kim H, Son JW, Hong GR. Outcomes of Severe Mitral Stenosis With the Revised Severity Criteria: Mitral Valve Replacement vs Percutaneous Mitral Valvuloplasty. Can J Cardiol 2024; 40:100-109. [PMID: 37716640 DOI: 10.1016/j.cjca.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/05/2023] [Accepted: 09/09/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND This study aimed to compare the outcomes, according to percutaneous mitral valvuloplasty (PMV) vs mitral valve replacement (MVR), of severe mitral stenosis (MS) with the updated criteria (MVA ≤ 1.5 cm2). METHODS From the Multicenter Mitral Stenosis With Rheumatic Etiology (MASTER) registry of 3140 patients, we included patients with severe MS who underwent PMV or MVR between January 2000 and December 2021 except for previous valvular surgery/intervention, at least moderate other valvular dysfunction, and thrombus at the left atrium/appendage. Moderately severe MS (MS-MS) and very severe MS (VS-MS) were defined as 1.0 cm2 < MVA ≤ 1.5 cm2 and MVA ≤ 1.0 cm2, respectively. Primary outcomes were a composite of cardiovascular (CV) death and heart failure (HF) hospitalization. Secondary outcomes were a composite of primary outcomes and redo intervention. RESULTS Among 442 patients (mean 56.5 ±11.9 years, women 77.1%), the MVR group (n = 260) was older, had more comorbidities, higher echoscore, larger left chambers, and higher right ventricular systolic pressure than the PMV group (n = 182). During a mean follow-up of 6.9 ± 5.2 years with inverse probability-weighted matching, primary outcomes did not differ, but the MVR group experienced fewer secondary outcomes (P = 0.010). In subgroup analysis of patients with MS-MS and VS-MS, primary outcomes did not differ. However, the MVR group in patients with VS-MS showed better secondary outcomes (P = 0.012). CONCLUSIONS PMV or MVR did not influence CV mortality or HF hospitalization in both MS-MS and VS-MS. However, because of increased early redo intervention in the PMV group in VS-MS, MVR would be the preferable option without clear evidence of suitable morphology for PMV.
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Affiliation(s)
- Dae-Young Kim
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea
| | - Iksung Cho
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyu Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Seo-Yeon Gwak
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyung Eun Ha
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hee Jeong Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyu-Yong Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong-Won Ha
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - William Dowon Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - In-Jai Kim
- Division of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, Pocheon, South Korea
| | - Seonhwa Lee
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea
| | - In-Cheol Kim
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea
| | - Kang-Un Choi
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Gyeongsan, South Korea
| | - Hojeong Kim
- Division of Physiology, Department of Biomedical Laboratory, Daegu Health College, Daegu, Korea
| | - Jang-Won Son
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Gyeongsan, South Korea
| | - Geu-Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.
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Leow R, Kong WKF, Li TYW, Poh KK, Sia CH, Yeo TC. Yeo's index: A novel index that combines anatomic and haemodynamic assessment of the severity of mitral stenosis. Int J Cardiol 2023; 392:131350. [PMID: 37689399 DOI: 10.1016/j.ijcard.2023.131350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND A mitral leaflet separation index (MLSI), measuring the anatomical separation of the mitral valve (MV) leaflet tips in diastole, was previously described as an accurate method of assessing mitral stenosis (MS). We propose a novel modification of the MLSI by including a hemodynamic assessment which we term Yeo's index that may improve its diagnostic performance. METHODS AND RESULTS We retrospectively studied 174 patients with varying severity of MS without significant mitral regurgitation, aortic valve disease or ventricular septal defect. MLSI was measured in 2 orthogonal views on transthoracic echocardiography as previously described. MV dimensionless index (DI) was calculated by dividing the left ventricular outflow tract pulsed-wave Doppler time velocity integral (TVI) by the MV continuous-wave Doppler TVI. We defined Yeo's index as the product of MLSI and DI. With linear correlation, Yeo's index demonstrated good correlation against MVA by planimetry (r = 0.728), pressure half-time (r = 0.677), and continuity equation (r = 0.829), with improved performance over the MLSI. Using ROC analysis, Yeo's index demonstrated good ability to correctly classify MS as severe (MVA ≤1.5cm2) (AUC 0.874, 95% CI 0.816-0.920). Yeo's index ≤0.260 cm correctly classified severe MS with sensitivity of 82% and specificity of 80%. Presence of AF did not affect the performance of Yeo's index. Yeo's index ≤0.147 cm also identified very severe MS (MVA ≤ 1.0 cm2) with specificity of 94% and sensitivity of 78%. CONCLUSION Yeo's index performed well in identifying severe MS and may be a useful adjunct to existing measures of MS severity.
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Affiliation(s)
- Ryan Leow
- Department of Cardiology, National University Heart Centre Singapore (NUHCS), Singapore
| | - William K F Kong
- Department of Cardiology, NUHCS, and the Department of Medicine, Yong Loo Lin School of Medicine (YLLSoM), National University of Singapore (NUS), Singapore
| | | | - Kian-Keong Poh
- Department of Cardiology, NUHCS, and the Department of Medicine, YLLSoM, NUS, Singapore
| | - Ching-Hui Sia
- Department of Cardiology, NUHCS, and the Department of Medicine, YLLSoM, NUS, Singapore
| | - Tiong-Cheng Yeo
- Department of Cardiology, NUHCS, and the Department of Medicine, YLLSoM, NUS, Singapore.
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Galusko V, Ionescu A, Edwards A, Sekar B, Wong K, Patel K, Lloyd G, Ricci F, Khanji MY. Management of mitral stenosis: a systematic review of clinical practice guidelines and recommendations. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 8:602-618. [PMID: 34878131 DOI: 10.1093/ehjqcco/qcab083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022]
Abstract
A number of guidelines exist with recommendations for diagnosis and management of mitral stenosis (MS). We systematically reviewed existing guidelines for diagnosis and management of MS, highlighting their similarities and differences, in order to guide clinical decision-making. We searched national and international guidelines in MEDLINE and EMBASE (5/4/2011-5/9/2021), the Guidelines International Network, Guideline Library, National Guideline Clearinghouse, National Library for Health Guidelines Finder, Canadian Medical Association Clinical Practice Guidelines Infobase, and websites of relevant organizations. Two independent reviewers screened titles and abstracts, and the full text of potentially relevant articles where needed. Selected guidelines were assessed for rigor of development; only guidelines with Appraisal of Guidelines for Research and Evaluation II instrument score >50% were included in the final analysis. Four guidelines were retained for analysis. There was consensus for percutaneous mitral balloon commissurotomy as first-line treatment of symptomatic severe rheumatic MS with suitable anatomy. In patients with unfavourable anatomy, surgical intervention should be considered. Exercise testing is indicated if discrepancy exists between symptoms and echocardiographic measurements. There was no clear divide between rheumatic MS and degenerative MS for their respective diagnoses and management. Pregnancy in severe MS is discouraged and the stenosis should be treated before conception. Long-term antibiotic prophylaxis is recommended for patients with rheumatic MS. Recommendations for the management of patients with mixed valvular diseases are lacking.
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Affiliation(s)
- Victor Galusko
- Department of Cardiology, King's College Hospital, London SE5 9RS, UK
| | - Adrian Ionescu
- Morriston, UK Cardiac Regional Centre, Swansea Bay Health Board, Swansea SA6 6NL, UK
| | - Amy Edwards
- Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, Glen Road, London E13 8SL, UK
| | - Baskar Sekar
- Morriston, UK Cardiac Regional Centre, Swansea Bay Health Board, Swansea SA6 6NL, UK
| | - Kit Wong
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Ketna Patel
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Guy Lloyd
- Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, Glen Road, London E13 8SL, UK
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Advanced Biomedical Technologies, G.d'Annunzio University, 66100 Chieti, Italy
- Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35-205 02, Malmö, SE-221 00, Sweden
- Department of Cardiology, Casa di Cura Villa Serena, 65013 Città Sant'Angelo, Pescara, Italy
| | - Mohammed Y Khanji
- Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, Glen Road, London E13 8SL, UK
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London EC1A 7BE, UK
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Ko KY, Cho I, Kim S, Seong Y, Kim DY, Seo JW, You SC, Shim CY, Hong GR, Ha JW. Identification of Distinct Subgroups in Moderately Severe Rheumatic Mitral Stenosis Using Data-Driven Phenotyping of Longitudinal Hemodynamic Progression. J Am Heart Assoc 2022; 11:e026375. [PMID: 35904199 PMCID: PMC9375495 DOI: 10.1161/jaha.121.026375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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 cm2) 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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Affiliation(s)
- Kyu-Yong Ko
- Division of Cardiology, Severance Hospital Yonsei University College of Medicine Seoul Korea
| | - Iksung Cho
- Division of Cardiology, Severance Hospital Yonsei University College of Medicine Seoul Korea
| | - Subin Kim
- Division of Cardiology, Severance Hospital Yonsei University College of Medicine Seoul Korea
| | - Yeonchan Seong
- Division of Cardiology, Severance Hospital Yonsei University College of Medicine Seoul Korea
| | - Dae-Young Kim
- Division of Cardiology, Severance Hospital Yonsei University College of Medicine Seoul Korea
| | - Ji Won Seo
- Division of Cardiology, Severance Hospital Yonsei University College of Medicine Seoul Korea
| | - Seng Chan You
- Department of Preventive Medicine Yonsei University College of Medicine Seoul Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Hospital Yonsei University College of Medicine Seoul Korea
| | - Geu-Ru Hong
- Division of Cardiology, Severance Hospital Yonsei University College of Medicine Seoul Korea
| | - Jong-Won Ha
- Division of Cardiology, Severance Hospital Yonsei University College of Medicine Seoul Korea
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10
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Bouchahda N, Kallala MY, Zemni I, Ben Messaoud M, Boussaada M, Hasnaoui T, Haj Amor H, Sassi G, Jarraya M, Mahjoub M, Hassine M, Betbout F, Gamra H. Left atrium reservoir function is central in patients with rheumatic mitral stenosis. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1257-1266. [PMID: 34971418 DOI: 10.1007/s10554-021-02509-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/24/2021] [Indexed: 11/29/2022]
Abstract
We investigated the relationship between Left Atrium strain reservoir function and symptoms and its impact on modulating Left Ventricular mechanics, diastolic filling, stroke volume, mean trans-mitral gradient and pulmonary pressure in mitral stenosis (MS) patients. We examined 195 full spectrum MS patients which were divided into two groups: Group 1 (n = 109) included patients with NYHA I & II functional class and group 2 (n = 86) included patients with NYHA III & IV functional class. LA strain reservoir function and classical echocardiographic parameters were calculated. LASr was significantly higher in group 1 versus group 2 in patients with MVA ≤ 1cm2 [8.8(6.0-12.6) vs 6.8(4.1-8.9), p = 0.03) and when 1cm2 < MVA ≤ 1.5 cm2 [10.0 (5.4-13.8) vs 6.7(4.5-9.0), p = 0.02). In patients with Pulmonary Hypertension, group 1 had significantly higher LASr than group 2 [11.1(6.6-14.8) vs 5.9(4.3-9.0), p = 0.002) By multivariate analysis, diabetes (OR = 4.11, 95%CI: 1.6-10.4), stroke (OR = 2.9, 95%CI: 1.1-7.9), LASr (OR = 0.9, 95%CI: 0.80-0.99) and LV ejection fraction (LVEF)(OR = 0.9, 95%CI: 0.91-0.99) were independently associated with NYHA functional class. LASr was significantly and positively correlated to MVA (r = 0.3, p < 10-3), stroke volume (r = 0.25, p = 10-3), mitral inflow (r = 0.4, p < 10-3) and LVEF(r = 0.14, p = 0.05). It was significantly and negatively correlated to left ventricular strain (r = -0.65, p < 10-3), LA indexed volume (r = -0.40, p < 10-3), maximum tricuspid regurgitation velocity (r = -0.25, p = 0.003), MTMG (r = -0.25, p = 10-3), and heart rate (r = -0.4, p < 10-3). We demonstrated a large range of interaction between LASr and mitral valve echocardiographic parameters. This may explain the reasons we identified LASr as an independent factor for MS functional tolerance.
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Affiliation(s)
- Nidhal Bouchahda
- Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16 Fattouma Bourguiba University Hospital, Rue du 1er juin 1955, 5000, Monastir, Tunisia.
| | - Mohamed Yassine Kallala
- Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16 Fattouma Bourguiba University Hospital, Rue du 1er juin 1955, 5000, Monastir, Tunisia
| | - Imen Zemni
- Department of Preventive Medicine, Faculty of Medicine, University of Monastir, Rue. Avicenne, 5019, Monastir, Tunisia
| | - Mejdi Ben Messaoud
- Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16 Fattouma Bourguiba University Hospital, Rue du 1er juin 1955, 5000, Monastir, Tunisia
| | - Mehdi Boussaada
- Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16 Fattouma Bourguiba University Hospital, Rue du 1er juin 1955, 5000, Monastir, Tunisia
| | - Taha Hasnaoui
- Cardiology Department, University Hospital Tahar Sfar, 5100, Mahdia, Tunisia
| | - Hassen Haj Amor
- Cardiology Department, University Hospital Tahar Sfar, 5100, Mahdia, Tunisia
| | - Ghada Sassi
- Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16 Fattouma Bourguiba University Hospital, Rue du 1er juin 1955, 5000, Monastir, Tunisia
| | - Marwa Jarraya
- Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16 Fattouma Bourguiba University Hospital, Rue du 1er juin 1955, 5000, Monastir, Tunisia
| | - Marwen Mahjoub
- Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16 Fattouma Bourguiba University Hospital, Rue du 1er juin 1955, 5000, Monastir, Tunisia
| | - Majed Hassine
- Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16 Fattouma Bourguiba University Hospital, Rue du 1er juin 1955, 5000, Monastir, Tunisia
| | - Fethi Betbout
- Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16 Fattouma Bourguiba University Hospital, Rue du 1er juin 1955, 5000, Monastir, Tunisia
| | - Habib Gamra
- Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16 Fattouma Bourguiba University Hospital, Rue du 1er juin 1955, 5000, Monastir, Tunisia
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Cupe-Chacalcaje K, Benites-Yshpilco L, Cachicatari-Beltrán A, Urdanivia-Ruiz D, Rafael-Horna E, Rojas P, Lévano-Pachas G, Baltodano-Arellano R. [Rheumatic mitral aggression. Usefulness of 3d transesophageal echocardiography]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2022; 3:98-111. [PMID: 37283602 PMCID: PMC10241339 DOI: 10.47487/apcyccv.v3i2.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 06/28/2022] [Indexed: 06/08/2023]
Abstract
Rheumatic heart disease is the leading cause of cardiovascular disease in children under 25 years of age worldwide, with the highest prevalence in low-income countries. The usual and distinctive finding of rheumatic aggression is mitral stenosis, which leads to serious cardiovascular consequences. International guidelines establish transthoracic echocardiography (TTE) as the diagnostic test for rheumatic heart disease; however, it has limitations in the measurement of planimetry and those inherent to Doppler. Transesophageal 3D echocardiography (TTE-3D) is a new modality that shows realistic images of the mitral valve and has the added value of accurately locating the plane of maximum stenosis and better determining commissural involvement.
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Affiliation(s)
- Kelly Cupe-Chacalcaje
- . Hospital Nacional Guillermo Almenara, LimaPerú. Hospital Nacional Guillermo Almenara Lima Perú
| | - Lindsay Benites-Yshpilco
- . Hospital Nacional Guillermo Almenara, LimaPerú. Hospital Nacional Guillermo Almenara Lima Perú
| | | | - Dante Urdanivia-Ruiz
- . Hospital Nacional Guillermo Almenara, LimaPerú. Hospital Nacional Guillermo Almenara Lima Perú
| | - Eliana Rafael-Horna
- . Hospital Nacional Guillermo Almenara, LimaPerú. Hospital Nacional Guillermo Almenara Lima Perú
| | - Paol Rojas
- . Hospital Nacional Guillermo Almenara, LimaPerú. Hospital Nacional Guillermo Almenara Lima Perú
| | - Gerald Lévano-Pachas
- . Hospital Nacional Guillermo Almenara, LimaPerú. Hospital Nacional Guillermo Almenara Lima Perú
| | - Roberto Baltodano-Arellano
- . Hospital Nacional Guillermo Almenara, LimaPerú. Hospital Nacional Guillermo Almenara Lima Perú
- . Universidad Nacional Mayor de San Marcos, Lima, Perú. Universidad Nacional Mayor de San Marcos Universidad Nacional Mayor de San Marcos Lima Peru
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