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The Natural History of Severe Calcific Mitral Stenosis

Nahoko Kato1, Ratnasari Padang2, Christopher G Scott3

  • 1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: https://twitter.com/nahoko_kato.

Journal of the American College of Cardiology
|June 20, 2020
PubMed

Insights

Severe calcific mitral stenosis (MS) patients face high mortality due to comorbidities, not symptoms. Key mortality predictors include inactivity, high comorbidity index, and elevated transmitral gradient (TMG).

Area of Science:

  • Cardiology
  • Valvular Heart Disease
  • Epidemiology

Background:

  • Calcific mitral stenosis (MS) prevalence rises with age, but its natural history and links to symptoms or comorbidities are unclear.
  • Understanding these factors is crucial for managing this condition.

Purpose of the Study:

  • To determine the prevalence of symptoms and comorbidities in severe calcific MS.
  • To identify predictors of all-cause mortality in these patients.

Main Methods:

  • Retrospective study of adults with isolated severe calcific MS (mitral valve area ≤1.5 cm²).
  • Data collected on symptoms, comorbidities (Charlson Comorbidity Index), inactivity, and mortality over a median follow-up of 2.8 years.

Main Results:

  • Calcific MS was found in 41% of severe MS patients (mean age 78 years).
  • Comorbidities were common (Charlson Comorbidity Index 5.1±1.7), with 7% inactive.
  • 1-year survival without intervention was 72%. Inactivity, high comorbidity index, elevated transmitral gradient (TMG ≥8 mmHg), and high right ventricular systolic pressure (≥50 mmHg) independently predicted mortality.

Conclusions:

  • Severe calcific MS patients have a high comorbidity burden and mortality risk without intervention.
  • Symptoms were not associated with mortality, but hemodynamic measures (TMG, RVSP) and comorbidity burden were significant predictors.
Abstract

Keywords:
echocardiographymitral stenosisvalve disease

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