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Prediction of successful outcome in 130 patients undergoing percutaneous balloon mitral valvotomy
V M Abascal1, G T Wilkins, J P O'Shea
1Department of Medicine, Massachusetts General Hospital, Boston 02114.
Insights
An echocardiographic score helps predict outcomes for patients undergoing percutaneous balloon mitral valvotomy. Lower scores (8 or less) indicate a higher likelihood of a good outcome, improving mitral valve area.
Area of Science:
- Cardiology
- Echocardiography
- Interventional Cardiology
Background:
- Percutaneous balloon mitral valvotomy (PBMV) is a key treatment for mitral stenosis.
- Predicting PBMV success based on pre-procedural patient characteristics is crucial for optimizing patient selection and outcomes.
Purpose of the Study:
- To analyze the relationship between echocardiographic scoring of mitral valve morphology and hemodynamic outcomes after PBMV.
- To determine the predictive value of an echocardiographic score for successful valvotomy.
- To assess the individual contribution of echocardiographic features to the change in mitral valve area.
Main Methods:
- Echocardiographic assessment of valvular morphology using a scoring system in 130 patients undergoing PBMV.
- Analysis of hemodynamic outcomes, including transmitral pressure gradient and mitral valve area.
- Correlation of the echocardiographic score and its components with changes in mitral valve area.
Main Results:
- Mean transmitral pressure gradient decreased significantly (16 to 6 mm Hg), and mitral valve area increased significantly (0.9 to 1.8 cm2) post-PBMV.
- An echocardiographic score of 8 or less predicted a "good" outcome (final valve area ≥1.5 cm2, increase ≥25%) in 84% of patients, versus 58% for scores of 8 or more.
- The echocardiographic score showed moderate negative correlation with the absolute increase in mitral valve area (r = -0.40), with valvular thickening being the strongest predictor (r = -0.47).
Conclusions:
- The echocardiographic scoring system is valuable in predicting hemodynamic success after percutaneous balloon mitral valvotomy.
- Pre-procedural echocardiographic assessment, particularly valvular thickening, can help anticipate the degree of mitral valve area improvement.
- This scoring system aids in patient selection and management for mitral stenosis treated with PBMV.
Abstract:
We studied 130 patients undergoing percutaneous balloon mitral valvotomy. The relation between valvular morphology according to a previously described echocardiographic scoring system and hemodynamic outcome expressed as qualitative ("good" and suboptimal) and as absolute change in valve area was analyzed. The relative importance of the individual components of this echocardiographic score (valvular thickening, mobility, calcification, and subvalvular disease) to the change in valve area after valvotomy was also examined. Mean transmitral pressure gradient decreased from 16 +/- 6 to 6 +/- 3 mm Hg (p less than 0.0001), and mitral valve area increased from 0.9 +/- 0.3 to 1.8 +/- 0.7 cm2 (p less than 0.0001). Results in individual patients were variable. Eighty-four percent (61 of 73) of patients with an echocardiographic score of 8 or less had a "good" outcome (final valve area greater than or equal to 1.5 cm2 and an increase in valve area of greater than or equal to 25%), whereas 58% (33 of 57) of patients with an echocardiographic score of 8 or more had a suboptimal result (p less than 0.001). The sensitivity of an echocardiographic score of 8 or less for predicting a "good" outcome was 72%, and the specificity was 73%. The echocardiographic score correlated negatively (r = -0.40, p less than 0.0001) with the absolute increase in mitral valve area after valvotomy, but there was substantial scatter in the data. Of the four components of the total echocardiographic score, valvular thickening correlated best with the absolute change in value area (r = -0.47, p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)