Abstract
Optimal time to perform percutaneous mitral valvuloplasty (PMV) for patients with significant mitral stenosis (MS) and atrial fibrillation (AF) remains controversial. We sought to identify prognostic factors and evaluate long-term clinical outcomes after PMV of 77 consecutive patients with MS with a mitral valve area (MVA) <1.5 cm2. According to baseline heart rhythm, these patients were divided into sinus rhythm (SR; n = 24) and AF (n = 53) groups. The study endpoint was defined as a composite of all-cause mortality, admission for heart failure, mitral valve surgery, repeated PMV, and major cerebral vascular accident during follow-up. After successful PMV, there was no significant difference between the two groups in post-MVA and post-mitral mean pressure gradient. However, the New York Heart Association Functional Classification post-procedure was worse in the AF group (p < 0.01). In the AF group, event-free survival during follow-up was significantly lower compared with that of the SR group (p = 0.016). Independent predictors of clinical events were AF [hazard ratio (HR), 2.73; 95 % confidence interval (CI), 1.04–9.36; p = 0.03] and pulmonary artery systolic pressure (HR 2.57; 95 % CI 1.18–5.47; p = 0.017). Patients with AF at baseline were significantly associated with worse symptoms and higher event rates after successful PMV compared with those with SR. The clinical benefit of PMV may be considered for patients with MVA <1.5 cm2 before the onset of AF.
Highlights
Since its introduction in 1984 by Inoue [1], percutaneous mitral valvuloplasty (PMV), which is well known as percutaneous transluminal mitral commissurotomy (PTMC), has been established as a safe and effective procedure for the treatment of symptomatic mitral stenosis (MS) [2,3,4]
The frequencies of New York Association functional classes (NYHA class) III and IV at baseline were significantly higher in the atrial fibrillation (AF) group compared with those of the sinus rhythm (SR)
There was no significant difference between the two groups in post-mitral valve area (MVA) and postmean mitral mean pressure gradient (MPG), whereas NYHA class post-procedure was worse in the AF group (p \ 0.01) (Fig. 2)
Summary
Since its introduction in 1984 by Inoue [1], percutaneous mitral valvuloplasty (PMV), which is well known as percutaneous transluminal mitral commissurotomy (PTMC), has been established as a safe and effective procedure for the treatment of symptomatic mitral stenosis (MS) [2,3,4]. The decrease in the incidence of acute rheumatic fever in developed countries led to a sharp decrease in the incidence of MS [5]. This decrease modifies clinical presentation, and MS is encountered in patients with the characteristics as follows: advanced age, atrial fibrillation (AF), history of surgical commissurotomy, repeated PMV, and severe impairment of valve anatomy. AF is associated with suboptimal immediate results and midterm outcome after PMV [8,9,10].
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