J Cardiovasc Imaging.  2019 Apr;27(2):122-133. 10.4250/jcvi.2019.27.e20.

Prognostic Implications of the Left Atrial Volume Index in Patients with Progressive Mitral Stenosis

Affiliations
  • 1Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea.
  • 2Division of Cardiology, Department of Internal Medicine, Myungji Hospital, Goyang, Korea.
  • 3Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea. hjchang@yuhs.ac

Abstract

BACKGROUND
Limited data are available on the prognosis of progressive mitral stenosis (MS). We evaluated the factors associated with adverse events in patients with progressive MS.
METHODS
We retrospectively analyzed 259 consecutive patients with pure progressive MS with a mitral valve area (MVA) between 1.5 and 2.0 cm². The primary outcome measures were a composite endpoint of cardiac death, heart failure hospitalization, mitral valve surgery or percutaneous mitral valvuloplasty, and ischemic stroke.
RESULTS
The mean patient age was 62 ± 12 years, and the mean MVA was 1.71 ± 0.15 cm². Over a median follow-up duration of 52 months, a total of 41 patients (18.3%) experienced the composite endpoint. In multivariable Cox regression analysis, prior stroke (hazard ratio [HR], 4.54; 95% confidence interval [CI], 2.16-9.54; p < 0.001) and left atrial volume index (LAVI) of > 50 mL/m² (HR, 4.45; 95% CI, 1.31-15.31; p = 0.017) were identified as independent predictors of the composite endpoint, even after adjusting for age and sex. Patients with a LAVI ≤ 50 mL/m² demonstrated favorable event-free survival compared with those with a LAVI > 50 mL/m² in either the overall population (p < 0.001) or asymptomatic patients (p = 0.002). Atrial fibrillation (AF), left ventricular mass index (LVMI), MVA, and mean diastolic pressure were factors independently associated with LAVI (all p < 0.05).
CONCLUSIONS
A deleterious impact of a high LAVI on outcome was observed in patients with progressive MS. The LAVI was mainly influenced by the presence of AF, the severity of MS, and LVMI in this population.

Keyword

Mitral stenosis; Left atrial volume; Prognosis

MeSH Terms

Atrial Fibrillation
Blood Pressure
Death
Disease-Free Survival
Follow-Up Studies
Heart Failure
Hospitalization
Humans
Mitral Valve
Mitral Valve Stenosis*
Outcome Assessment (Health Care)
Prognosis
Retrospective Studies
Stroke

Figure

  • Figure 1 Comparison of the ROC curves for the prediction of adverse events in patients with progressive mitral stenosis. Area under curve: LAVI = 0.701 (95% CI, 0.636–0.760), LVEF = 0.522 (95% CI, 0.454–0.590), LVMI = 0.538 (95% CI, 0.470–0.605), MVA = 0.514 (95% CI, 0.446–0.582), and MDPG = 0.538 (95% CI, 0.470–0.605). CI: confidence interval, LAVI: left atrial volume index, LVEF: left ventricular ejection fraction, LVMI: left ventricular mass index, MDPG: mean diastolic pressure gradient, MVA: mitral valve area, ROC: receiver-operating characteristic.

  • Figure 2 Kaplan-Meier curve showing the event-free survival rate for the composite primary endpoint stratified by the LAVI. Overall population (A) and asymptomatic patients (B). LAVI: left atrial volume index.

  • Figure 3 Kaplan-Meier curve showing the event-free survival rate for the individual endpoints stratified by the LAVI in the overall population. Cardiac death (A), HF hospitalization (B), MVR or PMV (C), and ischemic stroke (D). HF: heart failure, LAVI: left atrial volume index, MVR: mitral valve replacement, PMV: percutaneous mitral valvuloplasty.


Cited by  1 articles

Prognostic Value of Left Atrial Volume in Patients with Progressive Mitral Stenosis: A Possible Analogy with Left Ventricular Mass in the Setting of Pressure Overload
Jun-Bean Park
J Cardiovasc Imaging. 2019;27(2):134-136.    doi: 10.4250/jcvi.2019.27.e23.


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