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Dimensionless index of the mitral valve for evaluation of degenerative mitral stenosis
Author(s) -
Oktay Ahmet Afşin,
Riehl Russell,
Kachur Sergey,
Khan Zahoor,
Tutor Austin,
Chainani Vinod,
Cash Michael E.,
Shah Sangeeta,
Lavie Carl J.,
Morin Daniel P.,
Gilliland Yvonne E.,
Qamruddin Salima
Publication year - 2020
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.14847
Subject(s) - medicine , stenosis , cardiology , mitral valve stenosis , mitral valve , retrospective cohort study
Purpose Degenerative mitral stenosis (DMS) is an increasingly recognized cause of mitral stenosis. The goal of this study was to compare echocardiographic differences between DMS and rheumatic mitral stenosis (RMS), identify echocardiographic variables reflective of DMS severity, and propose a dimensionless mitral stenosis index (DMSI) for assessment of DMS severity. Methods This is a single‐center, retrospective cohort study. We included patients with at least mild MS and a mean transmitral pressure gradient (TMPG) ≥4 mm Hg. Mitral valve area by the continuity equation (MVA CEQ ) was used as an independent reference. The DMSI was calculated as follows: DMSI = VTI LVOT / VTI MV. All‐cause mortality data were collected retrospectively. Results A total of 64 patients with DMS and 24 patients with RMS were identified. MVA CEQ was larger in patients with DMS (1.43 ± 0.4 cm 2 ) than RMS (0.9 ± 0.3 cm 2 ) by ~0.5 cm 2 ( P = <.001), and mean TMPG was lower in the DMS group (6.0 ± 2 vs 7.9 ± 3 mm Hg, P = .003). A DMSI of ≤0.50 and ≤0.351 was associated with MVA CEQ ≤1.5 and MVA CEQ ≤1.0 cm 2 ( P < .001), respectively. With the progression of DMS from severe to very severe, there was a significant drop in DMSI. There was a nonsignificant trend toward worse survival in patients with MVA CEQ ≤1.0 cm 2 and DMSI ≤0.35, suggesting severe stenosis severity. Conclusion Our results show that TMPG correlates poorly with MVA in patients with DMS. Proposed DMSI may serve as a simple echocardiographic indicator of hemodynamically significant DMS.