Clinical and echocardiographic differences between rheumatic and degenerative mitral stenosis

Area of Science:

• Cardiology
• Valvular Heart Disease
• Epidemiology

Background:

• Degenerative mitral stenosis (DMS) prevalence is rising in developed nations, yet remains less understood than rheumatic mitral stenosis (RMS).
• Clinical and echocardiographic differences between DMS and RMS are significant, necessitating further investigation into their comparative impact on patient outcomes.

Purpose of the Study:

• To compare clinical characteristics and outcomes of patients with degenerative mitral stenosis (DMS) versus rheumatic mitral stenosis (RMS).
• To identify independent predictors of mortality and heart failure hospitalisation in patients with native-valve mitral stenosis (MS).

Main Methods:

• A retrospective observational study of 745 native-valve mitral stenosis (MS) cases with a median follow-up of 7.25 years.
• Comparison of clinical and echocardiographic parameters between DMS and RMS groups.
• Univariate and multivariate Cox regression analyses were performed to assess the composite outcome of all-cause mortality and heart failure hospitalisation.

Main Results:

• Patients with DMS were older (mean age 69.6 vs 51.6 years) and had higher rates of comorbidities like diabetes mellitus (41.9% vs 20.0%) compared to RMS.
• The proportion of degenerative mitral stenosis (DMS) cases increased significantly from 1.1% (1991-1995) to 41.0% (2016-2017).
• Independent predictors for the composite outcome included older age, diabetes mellitus, chronic kidney disease, and elevated pulmonary artery systolic pressure; however, mitral stenosis (MS) aetiology was not an independent factor.

Conclusions:

• Degenerative mitral stenosis (DMS) is an emerging primary cause of native-valve mitral stenosis (MS).
• Despite distinct clinical profiles, the aetiology of mitral stenosis (MS) did not independently predict the composite outcome of mortality or heart failure hospitalisation.