Nahoko Kato1, Ratnasari Padang2, Christopher G Scott3, Mayra Guerrero4, Sorin V Pislaru5, Patricia A Pellikka6. 1. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: https://twitter.com/nahoko_kato. 2. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota. 3. Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota. 4. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: https://twitter.com/MayraGuerreroMD. 5. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: https://twitter.com/SorinVPislaru. 6. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: Pellikka.Patricia@mayo.edu.
Abstract
BACKGROUND: Prevalence of calcific mitral stenosis (MS) increases with age; however, its natural history and relation to cardiac symptoms or comorbidities are not well defined. OBJECTIVES: This study assessed the prevalence of symptoms, comorbidities, and determinants of all-cause mortality in patients with severe calcific MS. METHODS: The authors retrospectively investigated adults with isolated severe calcific MS and mitral valve area ≤1.5 cm2 from July 2003 to December 2017. Inactivity was defined as requirement for assistance with activities of daily living. RESULTS: Of 491 patients with isolated severe MS, calcific MS was present in 200 (41%; age 78 ± 11 years, 18% men, 32% with atrial fibrillation). Charlson Comorbidity Index was 5.1 ± 1.7 and 14 (7%) were inactive. Mitral valve area and transmitral gradient (TMG) were 1.26 ± 0.19 cm2 and 8.1 ± 3.8 mm Hg, respectively. Symptoms were present at baseline in 120 (60%); 20 (10%) developed symptoms during follow-up of 2.8 ± 3.0 years. Kaplan-Meier survival at 1 year was 72% without intervention. Inactivity (hazard ratio [HR]: 6.59; 95% confidence interval [CI]: 3.54 to 12.3; p < 0.01), Charlson Comorbidity Index >5 (HR: 1.53; 95% CI: 1.04 to 2.26; p < 0.01), TMG ≥8 mm Hg (HR: 1.68; 95% CI: 1.12 to 2.51; p = 0.012), and right ventricular systolic pressure ≥50 mm Hg (HR: 2.27; 95% CI: 1.50 to 3.43; p < 0.01) were independently associated with mortality. Symptoms were not associated with mortality. CONCLUSION: Patients with isolated severe calcific MS had a high burden of comorbidities, resulting in high mortality without intervention. Symptoms were reported in 60%, but not associated with mortality. TMG ≥8 mm Hg and right ventricular systolic pressure ≥50 mm Hg were independently associated with mortality.
BACKGROUND: Prevalence of calcific mitral stenosis (MS) increases with age; however, its natural history and relation to cardiac symptoms or comorbidities are not well defined. OBJECTIVES: This study assessed the prevalence of symptoms, comorbidities, and determinants of all-cause mortality in patients with severe calcific MS. METHODS: The authors retrospectively investigated adults with isolated severe calcific MS and mitral valve area ≤1.5 cm2 from July 2003 to December 2017. Inactivity was defined as requirement for assistance with activities of daily living. RESULTS: Of 491 patients with isolated severe MS, calcific MS was present in 200 (41%; age 78 ± 11 years, 18% men, 32% with atrial fibrillation). Charlson Comorbidity Index was 5.1 ± 1.7 and 14 (7%) were inactive. Mitral valve area and transmitral gradient (TMG) were 1.26 ± 0.19 cm2 and 8.1 ± 3.8 mm Hg, respectively. Symptoms were present at baseline in 120 (60%); 20 (10%) developed symptoms during follow-up of 2.8 ± 3.0 years. Kaplan-Meier survival at 1 year was 72% without intervention. Inactivity (hazard ratio [HR]: 6.59; 95% confidence interval [CI]: 3.54 to 12.3; p < 0.01), Charlson Comorbidity Index >5 (HR: 1.53; 95% CI: 1.04 to 2.26; p < 0.01), TMG ≥8 mm Hg (HR: 1.68; 95% CI: 1.12 to 2.51; p = 0.012), and right ventricular systolic pressure ≥50 mm Hg (HR: 2.27; 95% CI: 1.50 to 3.43; p < 0.01) were independently associated with mortality. Symptoms were not associated with mortality. CONCLUSION:Patients with isolated severe calcific MS had a high burden of comorbidities, resulting in high mortality without intervention. Symptoms were reported in 60%, but not associated with mortality. TMG ≥8 mm Hg and right ventricular systolic pressure ≥50 mm Hg were independently associated with mortality.
Authors: Philippe B Bertrand; Timothy W Churchill; Evin Yucel; Mayooran Namasivayam; Samuel Bernard; Yasufumi Nagata; Wei He; Carl T Andrews; Michael H Picard; Arthur E Weyman; Robert A Levine; Judy Hung Journal: Eur Heart J Date: 2020-12-01 Impact factor: 29.983
Authors: Daniele Massera; Petra Buzkova; Anna E Bortnick; David S Owens; SongShou Mao; Dong Li; Ian H De Boer; Bryan R Kestenbaum; Matthew J Budoff; Jorge R Kizer Journal: Atherosclerosis Date: 2021-08-26 Impact factor: 5.162
Authors: Abdallah El Sabbagh; Rick A Nishimura; Mackram F Eleid; Sorin V Pislaru; Patricia A Pellikka; Charanjit S Rihal; Mayra Guerrero; David O Hodge; William R Miranda Journal: J Am Heart Assoc Date: 2022-05-16 Impact factor: 6.106