Incidence and Predictors of Long-Term Adverse Outcomes
in Patients with Rheumatic Mitral Stenosis in Sinus Rhythm
Patsadee Nachom MD*,
Nithima Ratanasit MD*
Affiliation :
* Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Rheumatic fever and rheumatic heart disease remain important health problems in developing countries.
Mitral stenosis (MS) is the most common form of rheumatic heart disease. The aim of this study was to investigate incidence
and echocardiographic predictors of long-term adverse outcomes in patients with rheumatic mitral stenosis in sinus rhythm.
Material and Method: We retrospectively reviewed medical records of patients diagnosed with isolated rheumatic MS of
any severity at Siriraj Hospital between 1996 and 2013. Demographic data, echocardiographic data, and long-term adverse
outcomes were collected. Long-term adverse outcomes included all-cause mortality, hospitalization due to heart failure,
new-onset atrial fibrillation, and/or embolic stroke during follow-up.
Results : One hundred eighty five patients (aged 41.9±13.2 years, 81.1% female) were included during the median follow-up
period of 12.6 years (95% CI: 11.2-14.0). MS was classified as mild, moderate, and severe in 8.6%, 27.6%, and 63.8% of
patients, respectively. Average mitral valve score was 8.25±1.5. Most patients (61.6%) underwent percutaneous balloon
mitral valvulotomy. Incidence of long-term adverse outcome was 43.2% (95% CI: 36.0-50.7%) and included mortality in
two patients (1.1%, 95% CI: 0.13-3.9%), hospitalization due to heart failure in 20 patients (10.8%, 95% CI: 6.7-16.2%),
new-onset atrial fibrillation in 71 patients (38.4%, 95% CI: 31.3-45.8%), and embolic stroke in 14 patients (7.6%, 95% CI:
4.2-12.4%). Echocardiographic parameters associated with long-term adverse outcomes were left atrial dimension greater
than 50 mm (HR 2.61, 95% CI: 1.08-6.30; p = 0.03) and left ventricular end-systolic dimension less than 28 mm (HR 3.06,
95%CI: 1.25-7.49; p = 0.01).
Conclusion : Long-term adverse outcomes are common in patients with rheumatic MS in sinus rhythm. Long-term adverse
outcomes were found to correlate with left atrial dimension and left ventricular end-systolic dimension.
Keywords : Echocardiography, Left atrium, Mitral stenosis, Rheumatic heart disease
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