Rheumatic mitral stenosis (MS) remains the most common type of valvular heart disease worldwide yet there are few studies on optimal timing of intervention in asymptomatic patients. Postulated benefits of intervention before symptom onset include prevention of left atrial dilation, atrial fibrillation (AF) and pulmonary hypertension leading to fewer thromboembolic events, less heart failure, preserved exercise capacity and in improved quality of life. In this issue of Heart , Kang and colleagues1 report a randomised clinical trial of in 374 patients with severe MS (valve area 1.0–1.5 cm2) comparing early percutaneous mitral commissurotomy (PMC) to conventional care. The primary composite endpoint of PMC-related complications, cardiovascular mortality, cerebral infarction and systemic thromboembolic events occurred in seven patients in the early PMC group (8.3%) compared with nine patients in the conventional care group (10.8%) (HR 0.77; 95% CI 0.29 to 2.07; p=0.61) at a median follow-up of 6 years (figure 1). Figure 1 Summary of the MITIGATE (mitral intervention vs conventional management in asymptomatic mitral stenosis) trial. MS, mitral stenosis; PMC, percutaneous mitral commissurotomy. Karthikeyan2 points out that there is only a sparse evidence base for management of mitral stenosis. Although this study by Kang and colleagues1 is commendable, replication in larger studies in countries with endemic rheumatic heart disease is needed. In the meanwhile, ‘even minimally symptomatic patients …

中文翻译：

---

心跳：风湿性二尖瓣狭窄的早期干预

风湿性二尖瓣狭窄 (MS) 仍然是世界范围内最常见的瓣膜性心脏病类型，但关于无症状患者最佳干预时机的研究很少。在症状出现之前进行干预的假定益处包括预防左心房扩张、心房颤动 (AF) 和肺动脉高压，从而减少血栓栓塞事件、减少心力衰竭、保持运动能力并提高生活质量。在本期《心脏》中，Kang 及其同事 1 报告了一项随机临床试验，该试验纳入了 374 名重度 MS（瓣膜面积 1.0-1.5 cm2）患者，将早期经皮二尖瓣连合切开术 (PMC) 与常规治疗进行了比较。PMC 相关并发症、心血管死亡率、早期 PMC 组中有 7 名患者 (8.3%) 发生脑梗塞和全身血栓栓塞事件，而常规治疗组有 9 名患者 (10.8%)（HR 0.77；95% CI 0.29 至 2.07；p=0.61）随访 6 年（图 1）。图 1 MITIGATE（无症状二尖瓣狭窄的二尖瓣干预与常规治疗）试验总结。MS，二尖瓣狭窄；PMC，经皮二尖瓣连合切开术。Karthikeyan2 指出，管理二尖瓣狭窄的证据基础很少。尽管 Kang 及其同事 1 的这项研究值得称道，但仍需要在风湿性心脏病国家的大型研究中进行复制。与此同时，“即使是症状轻微的患者…… 29 至 2.07；p=0.61）中位随访 6 年（图 1）。图 1 MITIGATE（无症状二尖瓣狭窄的二尖瓣干预与常规治疗）试验总结。MS，二尖瓣狭窄；PMC，经皮二尖瓣连合切开术。Karthikeyan2 指出，管理二尖瓣狭窄的证据基础很少。尽管 Kang 及其同事 1 的这项研究值得称道，但仍需要在风湿性心脏病国家的大型研究中进行复制。与此同时，“即使是症状轻微的患者…… 29 至 2.07；p=0.61）中位随访 6 年（图 1）。图 1 MITIGATE（无症状二尖瓣狭窄的二尖瓣干预与常规治疗）试验总结。MS，二尖瓣狭窄；PMC，经皮二尖瓣连合切开术。Karthikeyan2 指出，管理二尖瓣狭窄的证据基础很少。尽管 Kang 及其同事 1 的这项研究值得称道，但仍需要在风湿性心脏病国家的大型研究中进行复制。与此同时，“即使是症状轻微的患者…… Karthikeyan2 指出，管理二尖瓣狭窄的证据基础很少。尽管 Kang 及其同事 1 的这项研究值得称道，但仍需要在风湿性心脏病国家的大型研究中进行复制。与此同时，“即使是症状轻微的患者…… Karthikeyan2 指出，管理二尖瓣狭窄的证据基础很少。尽管 Kang 及其同事 1 的这项研究值得称道，但仍需要在风湿性心脏病国家的大型研究中进行复制。与此同时，“即使是症状轻微的患者……