Severity Of Mitral Valve Stenosis Research Articles

Relationship between New York functional class and duke activity status index with the severity of mitral valve stenosis and echocardiographic parameters: is left atrial strain a better predictor?

Purpose This study aimed to investigate the relationship between symptoms of patients with severe mitral stenosis (MS), evaluated by the New York Heart Association (NYHA) functional class and Duke Activity Status Index (DASI) score, and echocardiographic parameters. We evaluated patients with severe rheumatic MS diagnosed as mitral valve area (MVA) less than 1.5 cm2. All patients underwent transthoracic echocardiography and the left atrium (LA) reservoir auto-strain (LASr) analysis. In addition, DASI and NYHA scores were determined to evaluate the functional capacity and symptoms of MS patients. We evaluated 60 patients with MS with a mean age of 50.13 ± 10.28 and a median DASI score of 26.95 (26.38). There were 6 (10%) and 28 (46.7%) patients with NYHA class I and II, and 25 (40.0%) and 2 (3.3%) patients with NYHA class III and IV, respectively. NYHA class was positively correlated with LA area (LAA, r = 0.638), LA volume (LAV, r = 0.652), LAV index (LAVI, r = 0.62), E (r = 0.45), A (r = 0.25), and pulmonary artery pressure (PAP, r = 0.34), while negatively correlated with LASr (r=-0.73) and MVA (r=-0.417). Furthermore, the DASI score was positively associated with LASr (r = 0.81) and MVA (r = 0.52) while negatively correlated with LAA (r=-0.62), LAV (r=-0.65), LAVI (r=-0.56), E (r=-0.46), A (r=-0.3), and PAP (r= -0.32). Our findings indicate that LAA, LAV, LAVI, E, A, PAP, MVA, and LASr are associated with NYHA and DASI scores in MS patients. Additionally, the LASr had the strongest correlation between all measured parameters in severe MS patients.

Severity of Mitral Valve Stenosis - Possible Relationships With Blood Oxidant Markers and Antioxidants.

This study examined whether the severity of mitral valve stenosis (MVS) is associated with oxidative stress (OS) markers in the blood, and other hematological and clinicodemographic parameters.Methods and Results: This prospective study was conducted between March and May 2022. Seventy-five patients with newly diagnosed MVS (25 mild, 25 moderate, 25 severe) were included. Mild, moderate, and severe MVS was defined as MV area >2, 1.5-2, and <1.5 cm2, respectively. Various OS markers and laboratory parameters were determined in venous blood samples. For predictive analyses, 2 different analyses were performed to detect patients with severe MVS and those with moderate or severe (moderate/severe) MVS. Age (P=0.388) and sex (P=0.372) distribution were similar in the 3 groups. Multiple logistic regression analysis revealed that a high white blood cell (WBC) count (P=0.023) and high malondialdehyde (P=0.010), superoxide dismutase (SOD; P=0.008), and advanced oxidation protein products (AOPP; P=0.007) levels were independently associated with severe MVS. A low platelet count (P=0.030) and high malondialdehyde (P=0.018), SOD (P=0.008), and AOPP (P=0.001) levels were independently associated with having moderate/severe MVS. The best discriminatory factors for severe MVS were SOD (cut-off >315.5 ng/mL) and glutathione (cut-off >4.7 μmol/L). MVS severity seems to be affected by oxidant markers (malondialdehyde and AOPP), antioxidant enzymes (SOD), and inflammation-related cells (WBC and platelets). Future studies are needed to examine these relationships in larger populations.

The Effect of Gender on Triple Heart Valve Surgery Outcomes; Reinforcing Women's Health.

Female gender is a risk factor in several cardiac surgery risk stratification systems. This study explored the differences in the outcomes following triple heart valve surgery in men vs women. The study included 250 patients (males n = 101; females n = 149) who underwent triple valve surgery from 2009 to 2020. BMI (body mass index) was higher in females (29.6 vs 26.5kg/m2, P < .001), and diabetes was more common in males (44 vs 42%, P = .012). The ejection fraction was higher in females (55 vs 50%, P < .001). The severity of mitral valve stenosis and tricuspid valve regurgitation was significantly greater in females (33.11 vs 27.72%, P = .003 and 44.30 vs 19.8%, P < .001, respectively). Mitral valve replacement was more common in females (P < .001), and they had lower concomitant coronary artery bypass grafting (P = .001). Bleeding and renal failure were lower in females (P = .021 and <0.001, respectively). Hospital mortality, readmission, and reintervention were not significantly different between genders. By multivariable analysis, male gender was a risk factor for lower survival [HR (hazard ratio): 2.18; P = .024]. Triple valve surgery can be performed safely in both genders, with better long-term survival in females. Female gender was not a risk factor in patients undergoing triple valve surgery.

Discordance between mitral valve area (MVA) and pressure gradient in patients with mitral valve stenosis: mean transmitral valve gradient is a severity index or a tolerance index of severity of mitralss valve stenosis?

Le rétrécissement mitral (RM) rhumatismal demeure une valvulopathie fréquente dans les pays en voie de développement. Cependant, les pays industrialisés ont vu l'émergence ces dernières années de nouvelles étiologies de RM; notamment l'origine médicamenteuse et/ou toxique responsable de valvulopathies restrictives aussi bien sténosantes que régurgitantes. Pour cette raison, l'évaluation échocardiographique du RM et surtout, la définition de critères objectifs pour conclure au caractère serré du RM reste toujours d'actualité. Les objectifs du travail sont: évaluer l'existence ou non d'une corrélation directe entre le gradient moyen transmitral (GMT) et la sévérité du RM chez les patients porteurs d'un RM serré ou très serré (critère primaire) et analyser les différents paramètres qui conditionnent le gradient moyen transmitral (GMT) (Critère secondaire). Il s'agit d'une étude transversale monocentrique incluant tous les patients admis au service de Cardiologie du CHU Ibn Rochd de Casablanca pour un RM serré ou très serré, sur une période d'une année (Janvier 2014 à Décembre 2014). Nous avons analysés séparément deux groupes de patients : ceux avec un gradient moyen transmitral<10 mmHg (groupe 1) et ceux avec un gradient>10mmHg (groupe2). 50 patients porteurs d'un RM serré ou très serré ont été inclus. L'âge moyen de nos patients est de 41,7 ans avec prédominance féminine (sex ratio: 0,25). 64% de nos patients avaient un RM serré et 36% avaient un RM très serré. 52% (26 patients) avaient un GMT <10mmHg et 48% (24 patients) avaient un gradient moyen >10mmHg, ce qui suggère l'absence de corrélation directe entre la sévérité du RM et le GMT (coefficient de Pearson R: -0,137). Pour la dyspnée, 80% des patients du groupe 1 étaient dyspnéiques stade II de la NYHA et 70% des patients du groupe 2 étaient dyspnéiques stade III (41%) ou IV (29%) de la NYHA, ce qui signifie l'existence d'une corrélation significative entre le GMT et la sévérité de la dyspnée (R: 0,586 et p: 0,001). L'étude analytique de la fréquence cardiaque et la présence d'une décompensation cardiaque par rapport au gradient moyen transmitral a montré une corrélation significative. En effet, parmi les patients du groupe 1, 96% avaient une FC entre 60 et 100 bpm et aucun patient n'était en décompensation cardiaque. Dans le groupe 2,54% (13 patients) avaient une FC >100 bpm et 7 parmi eux (53%) étaient en décompensation cardiaque gauche. L'étude de la pression artérielle pulmonaire systolique dans les deux groupes de l'étude a révélé l'existence dans notre série d'une corrélation statistiquement significative (R : 0,518 et P : 0,001) entre la PAPS et le GMT. La régularité du rythme et la fonction ventriculaire droite n'étaient pas corrélées au GMT (R : 0,038 et R :-0,002 respectivement). Le gradient moyen transmitral est un bon indicateur de la tolérance du rétrécissement mitral, mais il reflète imparfaitement sa sévérité vue qu'il dépend de plusieurs paramètres hémodynamiques. D'authentiques rétrécissements mitraux très serrés peuvent exister avec des gradients moyens transmitraux <10 mm Hg, c'est pour cette raison que la valeur du GMT ne doit jamais être interprétée isolément.

Association of pentraxin-3 with the severity of rheumatic mitral valve stenosis

Objectives Infl ammation is involved in the pathogenesis of rheumatic mitral valve stenosis (RMVS). Pentraxin-3 (PTX3) indicates the infl ammatory state of humans. However, circulating PTX3 levels in patients with RMVS, remain largely unknown. In this study, we investigated whether there is an association between the severity of RMVS and PTX3.Methods All patients diagnosed as rheumatic mitral valvular stenosis between December 2013 and April 2014 were included in the study. We investigated circulating PTX3 and high-sensitivity C-reactive protein (hsCRP) levels in patients with RMVS and healthy controls.Results The study population included 72 subjects (41 patients with RMVS and 31 healthy subjects, 56 female) with a mean age of 40 ± 13 years. Patients with RMVS had higher left atrial diameters than healthy subjects. PTX3 and hsCRP were signifi cantly higher in patients with RMVS when compared to control subjects and this diff erence was more signifi cant in PTX3 compared to hsCRP (3.37 ± 1.11 vs 2.86 ± 0.59, P= 0.014 and 2.36 ± 1.48 vs 1.72 ± 0.73, P= 0.019, respectively). PTX3 was positively correlated with Wilkins score, mitral valvular area, mitral pressure gradient and left atrium diameter.Conclusions We demonstrated that plasma PTX3 and hsCRP levels were increased in patients with RMVS. Compared to hsCRP, PTX3 was more closely related with the severity of mitral valve stenosis. These fi ndings suggest that PTX3 may participate in the pathophysiology of RMVS.

Plasma NT‐proBNP is a potential marker of disease severity and correlates with symptoms in patients with chronic rheumatic valve disease

A noninvasive marker of disease severity and presence of symptoms is required in patients with chronic rheumatic valve disease (RVD). We sought to test the utility of measuring of N-terminal pro-B type natriuretic peptide (NT-proBNP) in chronic phase RVD. We also evaluated whether echocardiographic measures are interrelated with NT-proBNP levels. The study comprised 92 patients with RVD (mean age of 40+/-14 years) and 50 age/gender-matched control subjects. Functional status was assessed. Detailed echocardiographic examination was performed and mitral valve score was estimated. Venous blood samples were taken for measuring the level of NT-proBNP. The plasma levels of NT-proBNP rose with increasing severity of mitral valve stenosis (p<0.001), increasing severity of mitral valve score (p<0.001), increasing severity of clinical symptom (p<0.001), increasing severity of mitral regurgitation (p<0.013), presence of mitral valve calcification (p<0.001), presence of tricuspid valve stenosis (p<0.001), increasing severity of tricuspid regurgitation (p<0.011), presence of aortic stenosis (p=0.043), decreasing left ventricular ejection fraction (p<0.001), presence of left atrial thrombus (p=0.0019), and with increasing left atrium dimensions (p=0.002). NT-proBNP levels in patients with chronic RVD are a potential marker of disease severity and correlates with symptoms.

Angle of incidence does not affect accuracy of mitral stenosis area calculation by pressure half-time: Application to Doppler transesophageal echocardiography

Continuous wave Doppler transesophageal echocardiography (TEE) may allow the estimation of stenotic mitral valve area. Intuitively the posterolateral position of the transducer appears to limit the application of TEE for this purpose because of the excessive angle of incidence to mitral valve inflow. However, algebraic equations can be used to predict that the angle of incidence should not affect mitral valve area derived by using pressure half-time. To test the validity of this prediction and the potential application of Doppler TEE to estimate mitral valve area, 28 patients (21 women, 7 men) with a mean age of 59 ± 14 years with mitral stenosis were studied by continuous wave transthoracic echocardiography (TTE) and TEE guided color flow Doppler. TTE was performed from the apical four-chamber (TEE-0) and a modified parasternal four-chamber (TTE-MAL) plane as a means of intentionally increasing the angle of incidence. TEE was done by using the horizontal (TEE-HAX) and vertical (TEE-VAX) planes. Mitral valve area was calculated by pressure half-time method. Mean mitral valve area did not differ ( p = not significant [NS]) between TTE-0 (1.26 ± 0.84 cm 2), TTE-MAL (1.37 ± 0.94 cm 2), TEE-HAX (1.39 ± 0.92 cm 2), and TEE-VAX (1.35 ± 0.89 cm 2). The estimated mean angle of incidence during TTE-MAL was 45 ± 12 degrees (range 21 to 68 degrees). Six (21%) of 28 and 9 (32%) of 28 patients had an underestimation of transmitral peak velocities with TEE from the horizontal or vertical planes, respectively. However, excellent correlations were found between mitral valve area derived by using TEE-0 versus TTE-MAL ( r = 0.97; SEE = 0.25 cm 2; intercept = 0.02 cm 2; slope = 1.08; and p = 0.0001), TEE-HAX ( r = 0.91; SEE = 0.39 cm 2; intercept = 0.14 cm 2; slope = 1.00; and p = 0.0001) and TEE-VAX ( r = 0.92; SEE = 0.36 cm 2; intercept = 0.13 cm 2; slope = 0.97; and p = 0.0001). These results are directly applicable to Doppler TEE in the determination of mitral stenosis area by pressure half-time, whereby 21% to 32% of patients using the horizontal or vertical transesophageal planes may have a significant angle of incidence leading to underestimation of transmitral valve velocities. Future studies comparing Doppler TEE with cardiac catheterization are of interest. However, the present study suggests that Doppler TEE will play an important role in the hemodynamic assessment of the severity of mitral valve stenosis.

Detection of coronary artery disease by dipyridamole thallium tomography in mitral valve stenosis

The severity of mitral valve stenosis (MS) can be reliably estimated by ultrasound methods, 1 but the detection of concomitant coronary artery disease (CAD) is clinically difficult. Previous studies have suggested that exercise thallium scintigraphy is useful in the diagnosis of CAD in patients with valvular heart disease, 2 but there is little information on its value in patients with rheumatic MS. Conventional exercise scintigraphy may have low sensitivity in detecting CAD in patients with critical valve lesions due to the poor exercise tolerance of these patients. We report on the use of dipyridamole thallium tomography in diagnosing angiographically significant CAD in patients with MS.