Abstract
BackgroundThe prevalence of Rheumatic Mitral Stenosis (MS) has significantly changed over the last decades. We intend to examine patient demographics, Echocardiographic characteristics, procedural success rates, and complications throughout 30-years.MethodsWe conducted a single-center descriptive observational study. The study population consists of patients undergone percutaneous balloon mitral valvuloplasty (PBMV) at Emek Medical Center in Israel from January 1990 to May 2019.ResultsFour hundred seventeen patients underwent PBMV during the study period and were eligible for the study. Age did not change significantly over time (p = 0.09). The prevalence of Male and patients who were smoking and had multiple comorbidities such as hypertension, dyslipidemia, ischemic heart disease, and chronic kidney disease became increases over time (p = 0.02, p = 0.02, p = 0.001, p = 0.01, p = 0.02, and p = 0.001, respectively). Wilkins score and all its components increased over time, and the total score was higher in females (p = 0.01). Seventy-nine (18.9%) patients had complications. The rate of complications did not change over decades. Patients with Wilkins score > 8, post-procedural MR of ≥2, and post-procedural MVA < 1.5 had the highest risk for the need of Mitral valve replacement (MVR) surgery in 2 years following PBMV (3.64, 4.03, 2.44, respectively, CI 95%, p < .0001 for all). The median time in these patients was 630 days compared to 4–5 years in the entire population. Patients with Post-procedural MR of ≥2 and post-procedural MVA < 1.5 had ten times risk for developing heart failure (HR 9.07 and 10.06, respectively, CI 95%, P < .0001).ConclusionOur research reveals trends over time in patients’ characteristics and echocardiographic features. Our study population consists of more male patients with multiple comorbidities and more complex and calcified valvular structures in the last decade. Wilkins score > 8, post-procedural MR of ≥2, and post-procedural MVA < 1.5 cm2 were in-depended predictors for the time for surgery and heart failure hospitalization.
Highlights
Rheumatic heart disease (RHD) is a serious cardiac complication of an immune-mediated infectious disease known as a rheumatic fever caused by Streptococcus pyogenes infection in childhood
There was a significant increase in male patients’ rates, smoking, dyslipidemia, and chronic kidney disease, and this remained true after adjusting for age (p = 0.02, p = 0.001, p = 0.02, and p = 0.001, respectively). after adjusting for an age - there was an increasing trend in hypertension and ischemic heart disease (p = 0.02 and p = 0.01)
We identified three major factors that contribute the most for the prediction of Mitral valve replacement (MVR) surgery and the functional improvement and can help both the patient and the physician in gaining a better understanding of the long-term outcome of Percutaneous balloon mitral valvuloplasty (PBMV), aid in patients selection, assist the operator in planning a desire post-procedure mitral valve area’s dilatation (MVA) and proper medical treatment and adequate follow-up following the procedure
Summary
Rheumatic heart disease (RHD) is a serious cardiac complication of an immune-mediated infectious disease known as a rheumatic fever caused by Streptococcus pyogenes infection in childhood. The most prominent late manifestation of RHD is valvular dysfunction, which primarily affects the mitral and aortic valves. The prevalence of rheumatic fever in Israel was estimated in a large cohort study was 0.12%. A downward trend from the early 80s and highly influenced by Ethiopia’s latest immigration and the former Soviet Union. In this cohort, the prevalence of valvular disease was 15.7% in patients who had ARF [4]. The prevalence of Rheumatic Mitral Stenosis (MS) has significantly changed over the last decades. We intend to examine patient demographics, Echocardiographic characteristics, procedural success rates, and complications throughout 30-years
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