Rheumatic Mitral Stenosis Research Articles

Severe Mitral Stenosis Presenting as Chronic Liver Disease: A Rare Case Report

High Serum Ascites Albumin Gradient (SAAG) ascites in severe rheumatic mitral stenosis is very uncommon. Hereby, the authors present a similar case with this rare combination. The present case report describes a 42-year-old male with no history of hypertension or diabetes, but occasional alcohol consumption, who presented to department with complaints of recurrent anasarca over the past five years. The electrocardiogram showed an irregular R-R interval with no P waves, indicating atrial fibrillation. Ascitic fluid analysis revealed a high serum ascites albumin gradient with low ascitic protein levels. The patient responded well to treatment and was discharged with appropriate medications. He was referred to a higher centre with cardiothoracic surgical facilities for mitral valve replacement and tricuspid annuloplasty. The present case report highlights the uniqueness of the combination of severe rheumatic mitral stenosis and ascites.

The rare combination of pathologies: rheumatic mitral stenosis combined with supramitral ring.

The rare combination of pathologies: rheumatic mitral stenosis combined with supramitral ring.

Can rheumatic significant mitral stenosis be a cause of paradoxical low-flow, low-gradient in patients with severe aortic stenosis and preserved LVEF? Insights from 115 patients

Can rheumatic significant mitral stenosis be a cause of paradoxical low-flow, low-gradient in patients with severe aortic stenosis and preserved LVEF? Insights from 115 patients

Relationship between echocardiographic parameters and ALBI score in patients with rheumatic mitral stenosis.

An increase in the volume and pressure of the heart chambers has been shown to increase liver stiffness. The Albumin-Bilirubin (ALBI) score is useful and easy-to-use for objectively assessing liver function. There is no information in the literature regarding changes in ALBI scores in patients with rheumatic mitral stenosis (MS). The aim of our study was to investigate changes in ALBI score and its clinical impact in patients with MS.Of the 247 patients analyzed, 54 were excluded from the study. The remaining 193 patients with MS were divided into two groups: Group I (64 patients with mitral valve area > 1.5 cm2 and mean transmitral gradient < 10 mmHg) and Group II (129 patients with mitral valve area ≤ 1.5 cm2 and mean transmitral gradient ≥ 10 mmHg). The ALBI score was calculated based on serum albumin and total bilirubin levels using the following formula: ALBI= (log10 bilirubin [µmol/L] × 0.66) + (albumin [g/L] × - 0.085).A significant correlation was found between the ALBI score and mitral valve area in patients with MS (r = - 0.479, p < 0.001*) (Table4; Fig.3A). An ALBI score greater than - 2.61 was associated with severe MS (mitral valve area < 1.5 cm2), with a sensitivity of 72% and a specificity of 69% (Area under the ROC curve = 0.726; p < 0.001; 95% CI 0.650-0.802) (Fig.4A). A significant correlation was found between the ALBI score and mean transmitral gradient in patients with MS (r = 0.476; p < 0.001*) (Table4; Fig.3B). An ALBI score greater than - 2.57 was associated with severe MS (mean transmitral gradient < 10 mmHg), with a sensitivity of 65% and a specificity of 67% (Area under the ROC curve = 0.684; p < 0.001; 95% CI 0.608-0.759) (Fig.4B). In multivariate linear regression analysis, mitral valve area and mean transmitral gradient were significantly associated with increased ALBI scores (p < 0.05).Mitral valve area, mean transmitral gradient, and NT-proBNP levels were significantly associated with the ALBI score. The ALBI score could provide an information about the severity of MS. The ALBI score is a simple, evidence-based, objective, and discriminatory method for assessing liver function in patients with MS.Please check and confirm that the authors and their respective affiliations have been correctly identified and amend if necessary.Authors and their respective affiliations are correctly identified.

Correlation between mitral valve area and left atrial function in rheumatic mitral valve stenosis patients.

Rheumatic heart disease (RHD) continues to be one of the leading causes of cardiovascular morbidity and mortality. The mitral valve frequently develops mitral stenosis (MS), and it is the most prevalent valve lesion in patients with chronic RHD. Left atrial (LA) functional impairment is associated with rheumatic MS. The aim of this study was to evaluate the association between LA function and mitral valve area (MVA) in rheumatic MS patients, and to assess the echocardiographic parameters in sinus rhythm and atrial fibrillation (AF) patients. This was a cross-sectional, descriptive study that involved patients with rheumatic MS. Patients underwent a standard 12-lead electrocardiogram and echocardiographic examination. MVA was assessed and correlated with LA function. Comparison was made between sinus rhythm and AF patients. Eighty-one patients with rheumatic MS were included in this study, with 71.6% of them having associated MR. MVA showed a statistically highly significant positive correlation with LA and right ventricular (RV) function, and a statistically significant/highly significant negative correlation with their dimensions. A higher percentage of patients with severe MS was in AF (58.1%). There was a positive correlation between LA function and MVA in rheumatic MS patients. AF was related to the severity of MS.

Immediate, short-term, and long-term effects of balloon mitral valvuloplasty on the left atrial global longitudinal strain and its correlation to the outcomes in patients with severe rheumatic mitral stenosis

BackgroundLeft atrial global longitudinal strain (LA GLS) has been used as a new assessment tool for left atrial function. This article aims to investigate the effect of balloon mitral valvuloplasty (BMV) in patients with severe rheumatic mitral stenosis on LA GLS and its relation to the mitral valve area achieved after the procedure. The study included 95 patients with severe mitral stenosis who fulfilled the criteria for BMV (case group) and 80 normal healthy subjects (control group). All included participants underwent complete echocardiographic examinations. For the case group, LA GLS was assessed by 2D speckle-tracking Echocardiography before valvuloplasty, immediately after, within 24 h, at 6 months, and at 12 months, and the results were compared.ResultsThe impaired left-atrium strain in patients with severe mitral stenosis was improved immediately after BMV, and the improvement continued at 6 and 12 months post-BMV (23.1% ± 4.2 vs. 36.0% ± 4.9, 36.2% ± 4.5, and 40.1% ± 9.5, respectively p < 0.01). After BMV, there was a significant decrease in left atrial volume (76.3 ± 12.4 ml/m2 vs. 68.6 ± 10.4 ml/m2, p < 0.01) and a significant increase in the area occupied by the mitral valve (1.02 ± 0.18 cm2 vs. 1.60 ± 0.31 cm, p < 0.01). The immediate LA GLS and the mitral valve area were positively correlated (r = 0.64, p < 0.01). Furthermore, the immediate LA GLS was associated with significantly improved function class (p < 0.01).ConclusionsLA GLS can indicate left atrial (mainly reservoir) function. The improvement observed in patients after BMV may indicate that LA GLS can be used to evaluate the progress after BMV.Trial registration: The study was approved by the local ethics committee of the Faculty of Medicine in Minia University (Registration No. MUFMIRB 324-4-2022). Institutional Review Board, Faculty of Medicine, Minia University, Egypt. 324-4-2022, 24 18 April, 2022.

Segmental and global longitudinal strain measurement by 2-dimensional speckle tracking echocardiography in severe rheumatic mitral stenosis.

The present study aimed to detect subtle left ventricular (LV) dysfunction in patients with severe rheumatic mitral stenosis (MS) by measuring global and segmental longitudinal strain with a two-dimensional speckle tracking echocardiography (2D-STE) method. In this case-control study, 65 patients with severe rheumatic MS and preserved ejection fraction (EF ≥ 50% measured by conventional echocardiographic methods) were compared with 31 otherwise healthy control subjects. All patients underwent LV strain measurement by the 2D-STE method in addition to conventional echocardiography using a VIVID S60 echocardiography device. Absolute strain values in myocardial segments 1-8, 10, and 12 (all basal, mid anterior, mid anteroseptal, mid inferior, and mid anterolateral segments) were significantly lower in patients with severe MS compared with the control group (P < 0.05 for all). The absolute global longitudinal strain (GLS) value was higher in the control group (-19.56 vs. -18.25; P = 0.006). After adjustment for age, gender, and systolic blood pressure, the difference in GLS between the two groups was as follows: mean difference=-1.16; 95% CI: -2.58-0.25; P = 0.110. In patients with severe rheumatic MS and preserved EF, the absolute GLS tended to be lower than healthy controls. Furthermore, the segmental strain values of LV were significantly lower in most of the basal and some mid-myocardial segments. Further studies are warranted to investigate the underlying pathophysiology and clinical implications of this subclinical dysfunction in certain segments of patients with severe rheumatic MS.

Left atrial strain and risk of systemic embolic event in rheumatic mitral stenosis with sinus rhythm

Abstract Backgrounds Stroke and systemic embolism might be an important complication of rheumatic mitral stenosis (MS) even though patients are in sinus rhythm (SR), but the risk of embolic events in this population are not well studied. Purpose We aimed to evaluate the risk factors of embolic events in patients with rheumatic MS and SR. Methods From the multi-center retrospective registry of 2426 patients with rheumatic MS, we included patients with rheumatic MS and SR (n=583) between January 2000 and December 2021. After exclusion of patients who had history of systemic embolic events, taking the anticoagulants, combined significant aortic valve dysfunction, and a history of valve surgery. We finally analyzed 443 patients. The primary outcome was defined as composite of stroke, transient ischemic attack, noncentral nervous system embolism. Results Among 448 patients (77.1% female; mean age, 52.3 ± 10.1 years), systemic embolic events developed in 38 (8.4 %) patients with annual incidence rate of 4.6/100 person-year during mean follow-up period of 96.4 ± 61.1 months (median 94.2 months). Patients who had systemic embolic events were significantly older and had higher the prevalence of hypertension and diabetes than those who did not, without significant differences in left atrial (LA) dimensions, volumes, pulmonary artery systolic pressure. Instead, LA strain was significantly impaired in patients with systemic embolic events (19.1 ± 9.3 vs. 15.5 ± 8.07, p= 0.034). In the multivariate analysis, LA strain was independent predictors of systemic embolic events [HR 0.96, 95 % CI: 0.93-0.99; P = 0.021], after adjustment for confounding factors. The impaired LA strain (LA reservoir strain &amp;lt; 16.6 %) also had incremental prognostic value for development of systemic embolic events over clinical factors and traditional echocardiographic parameters (Figure). Conclusions Impaired LA strain is a predictor of stroke and systemic embolism in patients with rheumatic MS in SR. Considering the risk for embolism, oral anticoagulation might be considered in patients with rheumatic MS in SR and impaired LA strain.Figure

Multimodality imaging in PMV: comparison between cardiac computed tomography and echocardiography from multicenter mitral stenosis registry (MASTER registry)

Abstract Background The Wilkins score is a grading system that, from the past to the present, provides vital hints in patients with rheumatic mitral stenosis (MS). However even if the score is modest, complications may occur after percutaneous mitral valvuloplasty (PMV)1. Also Wilkins score alone does not reflect the development of various multi-modality imaging related to mitral stenosis. The purpose of this study was to evaluate the variability between echocardiography and cardiac computed tomography (CT) in measuring the score, and to examine the immediate PMV outcome related to the score measured by each modalities. Methods From the Multicenter mitrAl STEnosis with Rheumatic etiology (MASTER) registry of 3,140 patients with at least moderate MS, we included 96 rheumatic MS patients (age 56.4±11.5 years, 78 women) who underwent PMV and had remeasurable images between January 2010 and December 2022. We analyzed the discrepancies between the Wilkins score determined by echocardiography (transthoracic echocardiography or transesophageal echo in certain individuals) and the score determined by cardiac CT as a whole or among each parameter. Furthermore, the frequency of composite outcomes with high scores was compared between modalities. A composite outcome was defined as a case in which the outcome following PMV was not optimal (post PMV mitral valve area (MVA) less than 1.5 cm2 or mitral regurgitation (MR) with grade II-III or higher occurred). Results The average Wilkins score obtained by echocardiography was less than that measured by CT. (7.2±1.3 vs. 8.0±2.4) CT displayed higher score values than echocardiography, particularly for thickness (n= 47, 41.7%) and sub-valvular thickness (n= 40, 41.7%). Echo evaluated the presence of calcium, but CT showed no calcium in many cases. (n=19, 19.4% vs. n=38, 39.6%). Based on the previously commonly used Wilkins score of 9 points, when evaluated by echocardiography, there wasn't a significant difference except for the post MVA (1.6±0.2 vs. 1.5±0.2 cm2, p value = 0.015) between less than and more than 9 points. Yet, in 40 patients with a CT-evaluated Wilkins score of 9 or higher, the post MVA was substantially smaller (1.6±0.1 vs. 1.5±0.3 cm2, p = 0.019) than in those without, and MDPG remained elevated even after the procedure. (4.0±1.4 vs. 4.9 ± 1.9 mmHg, p = 0.017) In addition, there were more cases where the MVA remained less than 1.5 cm2 after the procedure (n=10, 17.9% vs. n=22, 55.0%, p&amp;lt;0.001). For this reason, the composite outcome found to be highly likely to occur. Even when the Wilkins score evaluated by echo was low, the composite outcome ratio was similarly high if the CT score was high. Conclusions The average value of the Wilkins score measured by echocardiography was lower than that measured by CT, mainly due to differences in leaflet thickness and sub-valvular thickness evaluation. Cases with a high Wilkins score evaluated by CT were more likely to have suboptimal MVA or significant MR after PMV.Wilkins score measured by each modalitieComposite event rate by Wilkins score

Impact of post-percutaneous mitral balloon valvuloplasty mitral valve area indexed for the body size on long-term outcomes in rheumatic mitral stenosis: a 20-year retrospective analysis

Abstract Introduction Percutaneous mitral balloon valvuloplasty (PBMV) remains one of the standard treatments for symptomatic rheumatic mitral stenosis (MS)(1). The procedural success criteria are generally defined as a post-procedural mitral valve area (MVA) of more than 1.5 cm2 without significant mitral regurgitation or in-hospital complications(2, 3). However, the effect of body size on the post-procedural MVA is not well examined. Purpose This study intended to investigate the association between the different methods of indexing post-PBMV MVA for the body size parameters and event-free survival compared to the absolute MVA in rheumatic MS patients treated with PBMV. Methods We retrospectively enrolled clinically significant rheumatic MS patients (MVA ≤1.5 cm2) who underwent PBMV with Inoue balloon between June 2002 and February 2021. The patients who experienced in-hospital complications (stroke, emergency surgery, or death) were excluded. A final number of 584 out of 618 patients were included in the analysis. Post-procedural MVA was assessed using echocardiographic 2D planimetry or pressure half-time if planimetry was not available. Post-PBMV MVA was indexed by body surface area (BSA), body mass index (BMI), body weight or height. The median value of absolute MVA and indexed MVA was used to stratify patients into two groups. The primary outcome was the composite of death, repeat PBMV, and mitral valve surgery. We performed Cox regression analyses to assess the association between groups and outcomes. C-index was calculated to assess the discriminative ability of each index. Results The mean age was 41.5 (±11.9) years, and 490 patients (82.8%) were female. The prevalence of atrial fibrillation was 39.5%. The median Wilkin score was 8 (interquartile range of 7-9). The mean pre-procedural and post-procedural MVA was 0.92 (±0.24) and 1.57 (±0.28) cm2, respectively. The average pre-procedural and post-procedural mean pressure gradient was 13.1 (±6.3) and 5.7 (±3.0) mmHg, respectively. The prevalence of post-procedural MR in a moderately severe to a severe degree was 3.8%. Over a median follow-up of 3.9 years, 194 composite events occurred. Patients with post-procedural indexed MVA of any type greater than a median were not associated with a significantly lower risk of primary outcome compared to those with indexed MVA less than the median (Picture 1). Moreover, absolute MVA greater than a median (1.55 cm2) was independently associated with a lower risk of primary outcome after adjusting with age and gender (Hazard ratio [95% CI] = 0.658 [0.493-0.879], p = 0.005). The discriminative ability of the absolute MVA was highest than the indexed MVA (Picture 2). Conclusion Indexing post-procedural MVA did not provide additional benefit on long-term risk stratification after PBMV compared with the absolute MVA.

Impact of procedural success definitions on long-term outcomes in patients with rheumatic mitral stenosis treated with percutaneous mitral valvuloplasty

Abstract Background Three different definitions of PBMV success have been reported in the literature. It is uncertain which definitions should be used in practice or clinical studies since there have been no comparative studies on the impact of these definitions on long-term outcomes after PBMV. Purpose We assessed the impact of the three PBMV success definitions on long-term outcomes in rheumatic MS patients treated with PBMV. Methods This was a retrospective study on consecutive severe rheumatic MS patients treated with PBMV in tertiary-care university hospital center between January 2003 and October 2020. Patients with in-hospital complications (death, emergency surgery or stroke) were excluded. Definition A was post-PBMV mitral valve area (MVA) ≥ 1.5 cm2 or ≥ 50% increase in MVA and mitral regurgitation less than 3+. Definition B was MVA ≥ 1.5 cm2 and MR ≤ 2+, and definition C was ≥ 50% increase in MVA or area of ≥ 1.5 cm2, with no more than 1 grade increment in MR severity. The patients were grouped according to success or no success according to each success definition. Cox regression analyses were performed to assess the associations between PBMV success and the composite outcome of all-cause death, mitral surgery or re-PBMV at long-term. Net reclassification improvement (NRI) was used to compare the impact of the success definitions. Results Of 589 patients included in the study, 83.2% were women with a mean age of 41.6 years and median Wilkin score of 8. The mean follow-up time was 5.5 years. The PBMV success rates according to the A, B and C definitions were 81.15%, 60.27% and 74.87%, respectively. Patients with PBMV success according to the A or B definitions had significantly lower risk of the composite outcome than those without success (success vs no success, definition A – HR 0.64, [95% CI 0.46-0.87], p 0.005, definition B – HR 0.71, [95% CI 0.53-0.94], p 0.016). Patients with PBMV success according to definition C had a similar risk of the composite outcome as those without success (HR 0.78, [95% CI 0.57-1.05], p 0.10). Patients with PBMV success according to definition A had a significantly lower risk of all-cause death than their counterparts (adjusted HR 0.57, [95% CI 0.38 - 0.86], p 0.006). The risk of death in patients with PBMV success according to the B or C definitions were similar to those without success. The c-indexes and 95% CIs for the composite outcomes of definitions A, B and C were 0.56 [0.52-0.60], 0.57 [0.52-0.61], and 0.54 [0.50-0.58], respectively. The A definitions discriminated the composite outcome better than the C definition (NRI – A vs. C 38.07%, [95% CI 13.18%-84.86%). The discriminative ability of the B definition was similar to the C definition (NRI - B vs. C 24.38%,[95% CI 11.37%-78.87%]). Conclusions The PBMV success rate varied among the different success definitions. The impact of success definitions A and B on long-term outcomes seemed to be better than the C definition.Characteristics of study patientsKaplan-Meier cumulative event

Thirty-year follow-up of patients submitted to percutaneous balloon mitral valvuloplasty for severe rheumatic mitral stenosis

Abstract Background Percutaneous balloon mitral valvuloplasty (PBMV) remains the mainstay of treatment for patients with severe rheumatic mitral stenosis (MS) and a favorable anatomy. Aim The present study aimed to assess very long-term outcomes after PBMV. Methods A retrospective analysis of PBMV performed at a single tertiary center between August 1991 and September 2022 was conducted. Successful PBMV was defined as a post-procedural functional mitral valve area (MVA) ≥1.5 cm2, mitral regurgitation less than moderate, and absence of in-hospital major cardiac or cerebrovascular events. The primary endpoint was composed of overall mortality and need for mitral reintervention (percutaneous and/or surgical). Results A total of 238 PBMV for severe rheumatic MS were conducted in our center during the specified timeframe (88.7% [n=211] female gender; mean age 48 ± 16 years; 48.6% [n=108] had atrial fibrillation [AFib]; 78.8% [n=149] had a Wilkins score ≤8). Acute success was achieved in 88% (n=198) procedures. Acute complications were present in 10.2% (n=23), mainly severe mitral regurgitation (n=10) and acute cerebrovascular events (n=5). During a mean follow-up of 15.3 ± 9.4 years, the incidence of the primary endpoint was 55% (n=131) (overall mortality 32.9% [n=77] and mitral valve reintervention 22.1% [n=54]). On bivariate analysis, higher age (p=0.042), presence of AFib (p=0.002), unsuccess of the procedure (p&amp;lt;0.001), acute complications (p=0.001) and larger left atrial (LA) diameter (p=0.05) were statistically significant for the occurrence of the primary endpoint. On multivariate analysis, larger LA diameter (hazard ratio [HR]: 1.03; 95% CI: 1.00-1.06; p=0.022), unsuccessful procedure (HR: 3.30; 95% CI: 1.56-7.01; p=0.002) and presence of complications (HR: 0.37; 95% CI: 0.17-0.84; p=0.017) were the only independent predictors of the primary endpoint. Conclusion In a large registry of patients submitted to PBMV for severe rheumatic MS, more than half met the primary endpoint for overall mortality or need for reintervention, up to 30 years after the procedure. This supports the dismal prognosis of this pathology. Prediction of late favorable results is multifactorial and appears to be determined by smaller LA diameter, absence of complications and acute success of the procedure.Event-free survival after PBMV

Abstract 14880: Optimizing Percutaneous Mitral Valvuloplasty for Rheumatic Mitral Stenosis: Clinical Significance of Mitral Valve Area Changes

Introduction: Percutaneous mitral valvuloplasty (PMV) is an established treatment for severe rheumatic mitral stenosis (RMS). However, there is limited data on the clinical significance of mitral valve area change (ΔMVA) during PMV on prognosis. Hypothesis: The prognosis improves with greater post-procedure ΔMVA. Methods: Data from the Multicenter mitrAl STEnosis with Rheumatic etiology (MASTER) registry, which included 3,140 patients with at least moderate RMS were analyzed. Out of those, patients with severe RMS (MVA &lt; 1.5 cm 2 ) who underwent their first PMV were included for analysis. Changes in echocardiographic parameters before and after PMV were calculated, and composite outcomes including all-cause death, heart failure admission, stroke, and mitral valve re-intervention were evaluated. Results: A total of 295 patients were included, and during the median follow-up of 91.1 months, composite outcomes occurred in 76 patients (16.5% in optimal and ΔMVA &gt; 0.5 cm2 group vs. 27.7% in optimal but ΔMVA ≤ 0.5 cm2 group vs. 35.7% in suboptimal group, respectively). Patients who achieved optimal results with ΔMVA &gt; 0.5 cm 2 had a better prognosis compared to other groups. (log-rank p=0.002). The group with optimal result but ΔMVA ≤ 0.5 cm2 had a higher risk for composite outcomes compared to the group with ΔMVA &gt; 0.5 cm2 (Hazard’s Ratio: 2.29, 95% confidence interval: 1.11-4.72, p=0.024). Conclusions: Achieving a significant increase in ΔMVA of at least 0.5 cm 2 can improve prognosis, and this could be recommended as an additional objective during PMV, in addition to the traditional optimal targets.

Abstract 13502: Obesity Paradox in Severe Rheumatic Mitral Stenosis: A Prospective Analysis Using a Machine Learning-Based Approach

Background: The obesity paradox posits that obese patients have better prognosis in cardiovascular diseases. Scarce data exists on the obesity paradox in rheumatic mitral stenosis (RMS) Hypothesis: Obesity is associated with a favorable prognosis in severe RMS Methods: Patients with severe RMS referred to a tertiary center from 2011 to 2022 were prospectively included. Patients with previous valve interventions were excluded; clinical and echocardiographic data were collected at baseline. Severe RMS was defined as a mitral valve area ≤ 1.5 cm2 by planimetry and patients were divided into 2 groups: (1) BMI ≥ 30 kg/m 2 ; (2) BMI &lt; 30 kg/m 2 . A combined outcome of percutaneous mitral valvuloplasty, mitral replacement and cardiovascular death was set. Logistic regression adjusted for confounders and gradient boosted decision-tree analysis were used Results: A total of 315 patients (82.2% female, mean age 53.3 years) were included. Over a median follow up of 30 months, 87% of patients had the outcome. MVA was higher in group 1 (p&lt;0.001) while left atrial volume index (LAVi) and net atrioventricular compliance were lower (p=0.008 both). Overall, BMI was not a good independent predictor of outcome (OR 0.98, 95% CI: 0.91-1.06, p=0.50) and occurrence of outcome was similar between groups (p=0.481). In both groups, mean importance of BMI in determining the outcome was similar (17.7 ± 6.1% and 17.0 ± 2.6% respectively) Conclusion: Obese patients had higher MVA and lower LAVi. However, our data suggests that BMI was not a significant independent predictor of poorer prognosis and its importance was not different between the groups. These findings challenge the obesity paradox in severe RMS

Abstract 12981: Digital Health for the Management of Oral Anticoagulation Therapy: A Systematic Review and Meta-Analysis

Background: Direct oral anticoagulants (DOACs) have progressively replaced vitamin K antagonists (VKAs). However, in certain conditions, especially antiphospholipid syndrome, mechanical heart valves and rheumatic mitral stenosis, VKAs remain the only drugs with established safety and efficacy. In low-income contexts, they are frequently the preferred option due to the high costs of DOACs. Its management is often challenging, and different digital health strategies have been implemented to support it. Aims: To systematically review the evidence on the impact of digital health strategies to support anticoagulation management compared to usual care on thromboembolic and bleeding events. Methods: Randomized controlled trials were searched in 5 databases from inception to September 2021. Two independent reviewers performed study selection, data extraction, and quality assessment using the Cochrane risk of bias tool (RoB2). Total thromboembolic events, major bleeding, mortality, and time in therapeutic range were assessed. Results were pooled using random effect models. Results: In total, 25 randomized controlled trials were included (25,746 patients) and classified as moderate to high risk of bias. Telemedicine resulted in a trend of reduced risk of thromboembolic events (13 studies, relative risk [RR] 0.75, 95% CI 0.53-1.07; I2=42%), comparable rates of major bleeding (11 studies, RR 0.94, 95% CI 0.82-1.07; I2=0%) and mortality (12 studies, RR 0.96, 95% CI 0.78-1.20; I2=11%), and an improved time in therapeutic range (16 studies, mean difference 3.38, 95% CI 1.12-5.65; I2=90%). In the subgroup of multitasking intervention, telemedicine resulted in an important reduction of thromboembolic events (RR 0.20, 95% CI 0.08-0.48). Conclusions: Digital health strategies resulted in similar rates of major bleeding and mortality, a trend for fewer thromboembolic events and better anticoagulation quality compared to standard care. Given the potential benefits of digital health-based care, such as greater access to remote populations, these findings may encourage further implementation of these strategies for anticoagulation management, particularly as part of multifaceted interventions for integrated care of chronic diseases.

Abstract 15170: Prognostic Implication of Left Atrial Reservoir Strain in Severe Mitral Stenosis With Low Transmitral Diastolic Pressure Gradient: Result From Long-Term Follow-Up Registry

Background: Prognosis of severe mitral stenosis (MS) with low transmitral mean diastolic pressure gradient (MDPG) has not been fully understood with lack of long-term follow-up study. Aims: We investigated the prognostic implication in severe MS with low MDPG. Methods: We included patients with severe rheumatic MS (mitral valve area [MVA] &lt; 1.5 cm 2 ) from the Multicenter mitrAl STEnosis with Rheumatic etiology (MASTER) registry. Patients with severe MS were categorized into high (≥ 5 mmHg) or low (&lt; 5 mmHg) MDPG groups. The primary outcome was a composite of all-cause mortality and stroke. Among 1,248 patients with severe MS, 322 (25.8%) had low and 926 (74.2%) had high MDPG. Results: Their mean age was 59±13 years, 25% were men, and 74% had atrial fibrillation. Patients with low MDPG were older and had a higher prevalence of atrial fibrillation. During a mean follow-up of 6.8±5.9 years, 194 patients (15.5%) experienced composite events. Patients with severe MS and low MDPG had a higher risk of experiencing composite events compared to those with high MDPG (hazard ratio [HR]: 1.56, 95% CI: 1.15-2.12; p=0.004). Subgroup analysis with low MDPG revealed that decreased left atrial reservoir strain (LARs) was independently associated with poorer outcome (HR, 2.58, 95% CI: 1.08-6.20; p=0.034). Conclusion: Severe MS patients with low MDPG are at higher risk of adverse events compared to those with high MDPG. The assessment of LARs can be useful in identifying subgroups of low MDPG severe MS patients with poor prognosis.

Left atrial size predicts long-term outcome after balloon mitral valvuloplasty.

The treatment of choice for severe rheumatic mitral stenosis is balloon mitral valvuloplasty (BMV). Numerous predictors of immediate and long-term procedural success have been described. The aims of this study were to describe our experience with BMV over the last decade and to evaluate predictors of long-term event-free survival. Medical records were retrospectively analyzed of patients who underwent BMV between 2009 and 2021. The primary outcome was a composite endpoint of all-cause mortality, mitral valve replacement (MVR), and repeat BMV. Long-term event-free survival was estimated using Kaplan-Meier curves. Logistic regression was used to create a multivariate model to assess pre-procedural predictors of the primary outcome. A total of 96 patients underwent BMV during the study period. The primary outcome occurred in 36 patients during 12-year follow-up: one (1%) patient underwent re-BMV, 28 (29%) underwent MVR, and eight (8%) died. Overall, event-free survival was 62% at 12 years. On multivariate analysis, pre-procedural left atrial volume index (LAVI) > 80 mL/m2 had a significant independent influence on event-free survival, as did previous mitral valve procedure and systolic pulmonary arterial pressure above 50 mmHg. Despite being a relatively low-volume center, excellent short and long-term results were demonstrated, with event-free survival rates consistent with previous studies from high-volume centers. LAVI independently predicted long-term event-free survival.

Comparison between interventional versus medical therapy in patients with rheumatic mitral valve stenosis in Tanzania.

Rheumatic heart disease remains the most common cardiovascular disease in children and young adults. The outcome of interventional versus medical therapy on the long term is not fully elucidated yet. This study provides contemporary data on the clinical profile, treatment and follow up of patients with rheumatic mitral stenosis (MS) in Tanzania. Patients' medical information, investigations and treatment data were recorded in this prospective cohort study. They were followed up for 6-24 months to determine the long-term outcome. Interventional therapy was defined as a combination of surgery and percutaneous balloon mitral valvuloplasty. Kaplan-Meier curves and Cox proportional hazards model were used in analyses. p-Value < 0.05 was considered statistically significant. We enrolled 290 consecutive patients. Interventions were done in half of the patients. Median follow up was 23.5 months. Mortality was higher in the medical than interventional treatment (10.4% vs. 4%, log-rank p = 0.001). Median age was 36 years, females (68.3%) and low income (55.5%). Multivalvular disease was found in 116 (40%) patients, atrial fibrillation (31.4%), stroke/transient ischaemic attack (18.9%) and heart failure class III-IV (44.1%). Median (IQR) duration of disease was 3 (4) years, secondary prophylaxis (27.7%) and oral anticoagulants use (62.3%). In multivariable analysis, the risk of death among patients on medical was 3.07 times higher than those on interventional treatment (crude HR 3.07, 95% CI 1.43-6.56, p = 0.004), 2.44 times higher among patients with arrhythmias versus without arrhythmias (crude HR 2.44, 95% CI 1.19-4.49, p = 0.015) and 2.13 times higher among patients with multivalvular than single valve disease (crude HR 2.13, 95% CI 1.09-4.16, p = 0.026). Intervention is carrying low mortality compared to medical treatment. Arrhythmias and multivalvular disease are associated with a high mortality. Rheumatic MS is more prevalent in young people, females and individuals with low income. There is a late hospital presentation and a low use of both secondary prophylactic antibiotics and anticoagulants.

Sleep Quality in patients with rheumatic mitral stenosis and the effect of percutaneous mitral balloon valvuloplasty on Sleep Quality

Background: Impaired sleep quality is common in patients with heart disease. However, data on the effects of mitral stenosis severity and percutaneous mitral balloon valvuloplasty on sleep quality are scarce.&#x0D; Materials and methods: 205 patients included in the study were divided into two groups as severe and non-severe (mild to moderate MS) rheumatic MS. 123 patients with mild to moderate MS and 82 patients with severe MS were analyzed. 82 patients with severe rheumatic MS who underwent percutaneous mitral balloon valvuloplasty were prospectively enrolled. Sleep quality was prospectively investigated immediately before and approximately six months after the percutaneous mitral balloon valvuloplasty procedure. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality.&#x0D; Results: The PSQI score was considerably higher in patients with severe MS compared to mild to moderate MS (3.7 ± 2.0 vs. 7.7 ± 2.9, p

Inoue percutaneous mitral commissurotomy in rheumatic mitral stenosis with variable echocardiographic scores

Inoue percutaneous mitral commissurotomy in rheumatic mitral stenosis with variable echocardiographic scores