Survival in Patients with Degenerative Mitral Stenosis: Results from a Large Retrospective Cohort Study

Pasca, Ioana; Dang, Patricia; Tyagi, Gaurav; Pai, Ramdas G.

doi:10.1016/j.echo.2015.12.012

Cited by 55 publications

(43 citation statements)

References 32 publications

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“…Fifty of these patients were assessed by echocardiography and 32 (64%) had MAC and DMS was present in 13 (26%) of these cases The progression of DMS is not well studied due to variability in diagnosing and grading MS in the presence of MAC. In a retrospective single‐center study, Pasca et al, reported poor survival in patients with DMS compared to the general population . In this study of 1004 patients with DMS, the 1‐ and 5‐ year survival rates were 78% and 47%, respectively.…”

Section: Introductionmentioning

confidence: 58%

“…DMS is usually progressive with increased calcium burden and with a 0.8 ± 2.4 mm Hg annual increase in the mean trans‐mitral gradient . In a single‐center study of 1004 patients, survival has been reported as 78% in one year and 47% in 5 years . Medical treatment is usually aimed at risk factor modification, prevention of thromboembolism, controlling atrial arrhythmias and preventing volume overload with diuretics.…”

Section: Mitral Annular/valve Calcification and Degenerative Mitral Smentioning

confidence: 99%

“…In this study of 1004 patients with DMS, the 1‐ and 5‐ year survival rates were 78% and 47%, respectively. Advanced severity of MS was associated with increased mortality . Diabetes mellitus has been reported to be associated with an accelerated progression of the disease.…”

Section: Introductionmentioning

confidence: 99%

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Degenerative mitral valve stenosis: Diagnosis and management

et al. 2019

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Mitral stenosis (MS) is a common valvular disease characterized by narrowing of the mitral valve orifice and a reduction in mitral valve area (MVA). While rheumatic MS (RMS) is frequently encountered in young individuals in developing countries, degenerative MS (DMS) is seen in the elderly in developed countries and its prevalence is increasing. DMS is usually a late presentation of mitral annular calcification (MAC). Accurate assessment of MVA in patients with MAC is challenging due to the alterations in the atrial and valvular structures as well as the presence of other comorbidities in this aging population. We will review the epidemiology, etiology, pathophysiology, diagnostic assessment, and management of DMS and compare the findings with RMS. The latest therapeutic approaches, including medical, surgical, and transcatheter valvular interventions, will be discussed.

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Section: Introductionmentioning

confidence: 58%

Section: Mitral Annular/valve Calcification and Degenerative Mitral Smentioning

confidence: 99%

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Degenerative mitral valve stenosis: Diagnosis and management

et al. 2019

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“…2 In patients with RMS, a mean TMPG of <5 mm Hg is suggestive of mild MS while a mean TMPG >10 mm Hg supports the diagnosis of severe MS. 49 Because of lack of a standardized definition and grading algorithm for DMS, Doppler-derived mean TMPG has commonly been used as the only criterion to grade MS in the epidemiologic studies in these patients. 56,57 Although the TMPG can be accurately measured with Doppler, several limitations impair its reliability as a marker or severity of MS. The TMPG is highly dependent on the heart rate, flow across the MV and atrioventricular compliance.…”

Section: Doppler-derived Transmitral Pressure Gradientmentioning

confidence: 99%

“…56 Their single-center study was conducted on a cohort of 1004 DMS patients with a mean follow-up period of 3.5±2.8 years.…”

Section: Natural History Of Degenerative Mitral Stenosismentioning

confidence: 99%

Echocardiographic Assessment of Degenerative Mitral Stenosis: A Diagnostic Challenge of an Emerging Cardiac Disease

Oktay¹,

Gilliland²,

Lavie³

et al. 2017

Current Problems in Cardiology

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Impact of renin‐angiotensin system inhibitors on long‐term clinical outcomes of patients with rheumatic heart disease

Liu

Lai

et al. 2021

ESC Heart Failure

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Aims Rheumatic heart disease (RHD) remains a major global health problem. Renin-angiotensin-aldosterone system inhibitors (RAASi) are commonly administered in the treatment of cardiovascular disease, but its role in RHD patients is still limited. We performed a retrospective study to determine the effect of RAASi on long-term outcomes for RHD patients. Methods and results A 1:1 propensity score matching was implemented to balance baseline characteristics between groups RAASi and non-RAASi. Cox proportional hazards regression model was used to investigate the associations of RAASi with the risks of all-cause mortality, cardiovascular death (CVD), and cerebrovascular death. Binary logistic regression analysis was used to evaluate the associations of RAASi with the risks of 1, 3, and 5 year heart failure (HF) rehospitalization, new-onset atrial fibrillation (AF), and new-onset stroke. A total of 734 RHD patients were enrolled as study participants; nearly half of these participants had combined valve damage (54.4%), worse New York Heart Association functional class status (III and IV, 55.2%), surgical treatment (54.2%), and AF (65.0%). After propensity score matching, 514 RHD patients were finally analysed. RAASi treatment was associated with decreased risks of all-cause mortality [adjusted hazard ratio (HR) = 0.52, 95% confidence interval (CI): 0.37-0.73, P < 0.001], CVD (adjusted HR = 0.48, 95% CI: 0.30-0.76, P = 0.002), and cerebrovascular death (adjusted HR = 0.22, 95% CI: 0.08-0.60, P = 0.003). Further subgroup analysis showed that RAASi treatment was associated with decreased risks of all-cause mortality (adjusted HR = 0.50, 95% CI: 0.31-0.79, P = 0.004), CVD (adjusted HR = 0.48, 95% CI: 0.25-0.91, P = 0.025), and cerebrovascular death (adjusted HR = 0.19, 95% CI: 0.05-0.65, P = 0.008) in RHD patients without surgical treatment, and better effect was observed in RHD patients with surgical treatment on the risks of all-cause mortality (adjusted HR = 0.47, 95% CI: 0.26-0.85, P = 0.012) and CVD (adjusted HR = 0.43, 95% CI: 0.21-0.90, P = 0.024) except cerebrovascular death (adjusted HR = 0.52, 95% CI: 0.08-3.36, P = 0.491). RAASi treatment was associated with decreased HF rehospitalization risk of 1 year [adjusted odds ratio (OR) = 0.38, 95% CI: 0.23-0.61, P < 0.001], 3 year (adjusted OR = 0.43, 95% CI: 0.28-0.68, P < 0.001), and 5 year (adjusted OR = 0.48, 95% CI: 0.30-0.77, P = 0.002) as well as new-onset AF risk (adjusted OR = 0.38, 95% CI: 0.21-0.68, P = 0.001). RAASi treatment had nothing to do with new-onset stroke risk (adjusted OR = 0.80, 95% CI: 0.47-1.38, P = 0.428). Conclusion Renin-angiotensin-aldosterone system inhibitor treatment was significantly associated with decreased risks of mortality, HF rehospitalization, and new-onset AF in RHD patients in median 5.9 year follow-up.

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Survival in Patients with Degenerative Mitral Stenosis: Results from a Large Retrospective Cohort Study

Cited by 55 publications

References 32 publications

Degenerative mitral valve stenosis: Diagnosis and management

Degenerative mitral valve stenosis: Diagnosis and management

Echocardiographic Assessment of Degenerative Mitral Stenosis: A Diagnostic Challenge of an Emerging Cardiac Disease

Impact of renin‐angiotensin system inhibitors on long‐term clinical outcomes of patients with rheumatic heart disease

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