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Clinical and echocardiographic differences in three different etiologies of severe mitral stenosis

Shunsuke Kagawa1, Taku Omori1, Goki Uno1

  • 1Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.

Echocardiography (Mount Kisco, N.Y.)
|April 4, 2022
PubMed
Abstract

Insights

Mitral stenosis (MS) from different causes have distinct clinical features. Post-clip MS shows a lower pressure gradient, while rheumatic MS (RMS) has more dyspnea, despite similar valve areas.

Area of Science:

  • Cardiology
  • Echocardiography
  • Valvular Heart Disease

Background:

  • Mitral stenosis (MS) is categorized into rheumatic MS (RMS), degenerative MS, and post-transcatheter mitral valve repair MS (post-clip MS).
  • Clinical distinctions among these MS etiologies remain unclear.

Purpose of the Study:

  • To investigate the clinical differences among rheumatic MS, degenerative MS, and post-clip MS.
  • To identify specific determinants of dyspnea in each MS etiology.

Main Methods:

  • Retrospective analysis of 293 patients with MS (mitral valve area ≤1.5 cm²).
  • Categorization into RMS (n=53), degenerative MS (n=118), and post-clip MS (n=122).
  • Utilized three-dimensional transesophageal echocardiography (3D-TEE) and transthoracic echocardiography.

Main Results:

  • No significant difference in 3D-TEE-derived mitral valve area (MVA) across the three groups.
  • Post-clip MS patients exhibited a significantly lower mean transmitral pressure gradient (p < .001).
  • Rheumatic MS patients had a higher prevalence of dyspnea.

Conclusions:

  • Post-clip MS is associated with the lowest mean transmitral pressure gradient, and RMS with the highest dyspnea prevalence, despite similar MVAs.
  • Determinants of dyspnea vary significantly across the three MS etiologies: pressure half-time in RMS, MVA and right atrial pressure in degenerative MS, and left ventricle ejection fraction in post-clip MS.
Keywords:
degenerative mitral stenosisdyspneapost-clip mitral stenosisrheumatic mitral stenosis

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