Prognostic implications of the left atrial volume index in patients with progressive mitral stenosis

In Jeong Cho, Hyeonju Jeong, Jah Yeon Choi, Sang Eun Lee, Hyuk Jae Chang

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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.

Original languageEnglish
Pages (from-to)122-133
Number of pages12
JournalJournal of Cardiovascular Imaging
Volume27
Issue number2
DOIs
Publication statusPublished - 2019 Apr

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All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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