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The Natural History of Severe Calcific Mitral Stenosis
Journal of the American College of Cardiology ( IF 21.7 ) Pub Date : 2020-06-01 , DOI: 10.1016/j.jacc.2020.04.049
Nahoko Kato 1 , Ratnasari Padang 1 , Christopher G Scott 2 , Mayra Guerrero 1 , Sorin V Pislaru 1 , Patricia A Pellikka 1
Affiliation  

BACKGROUND Prevalence of calcific mitral stenosis (MS) increases with age; however, its natural history and relation to cardiac symptoms or comorbidities are not well defined. OBJECTIVES This study assessed the prevalence of symptoms, comorbidities, and determinants of all-cause mortality in patients with severe calcific MS. METHODS The authors retrospectively investigated adults with isolated severe calcific MS and mitral valve area ≤1.5 cm2 from July 2003 to December 2017. Inactivity was defined as requirement for assistance with activities of daily living. RESULTS Of 491 patients with isolated severe MS, calcific MS was present in 200 (41%; age 78 ± 11 years, 18% men, 32% with atrial fibrillation). Charlson Comorbidity Index was 5.1 ± 1.7 and 14 (7%) were inactive. Mitral valve area and transmitral gradient (TMG) were 1.26 ± 0.19 cm2 and 8.1 ± 3.8 mm Hg, respectively. Symptoms were present at baseline in 120 (60%); 20 (10%) developed symptoms during follow-up of 2.8 ± 3.0 years. Kaplan-Meier survival at 1 year was 72% without intervention. Inactivity (hazard ratio [HR]: 6.59; 95% confidence interval [CI]: 3.54 to 12.3; p < 0.01), Charlson Comorbidity Index >5 (HR: 1.53; 95% CI: 1.04 to 2.26; p < 0.01), TMG ≥8 mm Hg (HR: 1.68; 95% CI: 1.12 to 2.51; p = 0.012), and right ventricular systolic pressure ≥50 mm Hg (HR: 2.27; 95% CI: 1.50 to 3.43; p < 0.01) were independently associated with mortality. Symptoms were not associated with mortality. CONCLUSION Patients with isolated severe calcific MS had a high burden of comorbidities, resulting in high mortality without intervention. Symptoms were reported in 60%, but not associated with mortality. TMG ≥8 mm Hg and right ventricular systolic pressure ≥50 mm Hg were independently associated with mortality.

中文翻译:

严重钙化二尖瓣狭窄的自然史

背景钙化性二尖瓣狭窄 (MS) 的患病率随着年龄的增长而增加。然而,其自然病程以及与心脏症状或合并症的关系尚不明确。目的 本研究评估了严重钙化性 MS 患者的症状、合并症和全因死亡率的决定因素。方法 作者回顾性调查了 2003 年 7 月至 2017 年 12 月间患有孤立性严重钙化性 MS 且二尖瓣面积≤1.5 cm2 的成年人。不活动被定义为需要协助进行日常生活活动。结果 在 491 名孤立性严重 MS 患者中,200 名存在钙化性 MS(41%;年龄 78 ± 11 岁,18% 男性,32% 患有心房颤动)。Charlson 合并症指数为 5.1 ± 1.7 且 14 (7%) 处于非活动状态。二尖瓣面积和二尖瓣梯度 (TMG) 为 1.26 ± 0.19 cm2 和 8。分别为 1 ± 3.8 毫米汞柱。120 人(60%)在基线时出现症状;20 (10%) 名患者在 2.8 ± 3.0 年的随访期间出现症状。在没有干预的情况下,1 年的 Kaplan-Meier 生存率为 72%。不活动(风险比 [HR]:6.59;95% 置信区间 [CI]:3.54 至 12.3;p < 0.01),Charlson 合并症指数 >5(HR:1.53;95% CI:1.04 至 2.26;p < 0.01), TMG ≥ 8 mm Hg(HR:1.68;95% CI:1.12 至 2.51;p = 0.012)和右心室收缩压≥50 mm Hg(HR:2.27;95% CI:1.50 至 3.43;p < 0.01)与死亡率独立相关。症状与死亡率无关。结论 孤立的严重钙化性 MS 患者有很高的合并症负担,导致在没有干预的情况下死亡率很高。60% 的患者报告了症状,但与死亡率无关。
更新日期:2020-06-01
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