Abstract
Abstract Background The shift in mitral stenosis (MS) aetiology from rheumatic to calcific valve disease, commonly seen in elderly patients with cardiomyopathy, challenges the differentiation between valve- or tissue-related causes of haemodynamic abnormalities. Purpose This study examines the impact of left-heart myopathy on the echocardiographic assessment of MS severity and acute haemodynamic effects following mitral valve (MV) intervention. Methods The CircAdapt model of the human cardiovascular system was used to evaluate the effect of MS on cardiac haemodynamics in a virtual patient cohort with broad ranges of impaired left atrial (LA) function and reduced left ventricular (LV) compliance. Mean gradient (MG) and pressure half-time (PHT) were derived for MS severity assessment, alongside LV and LA pressure traces to quantify the haemodynamic consequence of MV intervention. Results Depending on myocardial abnormalities, the MG varied by only 10%, 5% and 5% for mild, moderate and severe MS, respectively. Reduced LV compliance resulted in disproportionately lower PHT causing overestimation of the PHT-derived MV area up to 1.43 cm2. Following virtual MV intervention for moderate to severe MS, mean left atrial pressure (mLAP) decreased by 50% in presence of healthy myocardium but only 4% for combined LV and LA dysfunction. In patients with reduced LV compliance, LV end-diastolic pressure remained elevated despite MV intervention. Conclusions The virtual patient cohorts indicate that the MG is a robust metric for MS severity regardless of left-heart myopathy, whereas PHT may reveal underlying impaired LV compliance. However, neither MG nor PHT predict changes in mLAP following intervention. Recognizing the significance of distinguishing between increased left-heart pressures driven by valvular or tissue factors is therefore crucial for clinical decision-making. graphical abstract methods
Published Version
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