Abstract 13445: The Prognostic Value of Pulmonary Hypertension and Atrial Fibrillation in Rheumatic Mitral Stenosis

Abstract

Introduction and Hypothesis: Rheumatic mitral stenosis (MS) is decreasing in developed countries; however, there has been a substantial number of patients with rheumatic MS in developing countries. Although the current international guideline of valvular heart disease defined the severe MS as MVA below 1.5 cm 2 and the new onset of atrial fibrillation (Afib) and pulmonary hypertension is one of the indications of MV intervention in asymptomatic severe rheumatic MS, there have been scarce supporting data. Therefore, we sought to investigate the prognostic value of Afib and pulmonary hypertension in severe rheumatic MS. Methods: We retrospectively collected data on rheumatic MS in a single center from 2006 to 2022. The clinical, echocardiographic characteristics and clinical outcomes were investigated. The incidence of major cardiovascular adverse events (MACE) including all-cause mortality, hospitalization for heart failure, and the thromboembolic event was investigated following 10 years. Results: A total of 792 patients were collected. The mean age of the population was 63 years old, the number of females was 71.8%, and the incidence of severe MS (MVA≤1.5 cm 2 ) was 37.4%. In patients with severe stenosis, there was no significant difference in MACE in Afib and non-Afib patients during the 10 years follow-up (Figure A). However, the presence of pulmonary hypertension, esp. pulmonary arterial systolic pressure above 50mmHg, demonstrated significantly worse clinical outcomes (Figure B). In multivariable Cox analysis, pulmonary hypertension (PASP≥50mmHg) was a significant prognostic factor of MACE after adjusting other covariables (HR 1.897, 95% CI: 1.352-2.663, p-value <0.001). Conclusions: In severe rheumatic MS, the presence of pulmonary hypertension, not Afib, was a significant prognostic factor for clinical outcome. Further study with a larger population would be needed for more precise risk stratification and indication for MV intervention.