Background:In contemporary patients with suspected significant mitral stenosis (MS) undergoing rest and treadmill stress echocardiography, we assessed characteristics and factors associated with longer-term survival.Methods:We studied 515 consecutive patients (asymptomatic/atypical symptoms, mean left ventricular ejection fraction 58±2%; 43% male) with suspected at least moderate MS ([1] native mitral valve [MV]: resting mean MV gradient ≥5 mm Hg or area ≤1.5 cm² and [2] prosthetic valve: resting mean MV gradient ≥5 mm Hg or effective orifice area ≤2 cm) who underwent rest and treadmill stress echocardiography between 1/2003 and 12/2013. MS was categorized as rheumatic (n=170, 33%), postsurgical (prior mitral repair/replacement, n=245, 48%), and primary nonrheumatic (n=100, 19%). Primary outcome was all-cause mortality.Results:Mean resting MV gradient and right ventricular systolic pressure were 8.5±3 and 39±13 mm Hg. Patients achieved 95±29% age-sex predicted metabolic equivalents; peak-stress MV gradient and right ventricular systolic pressure were 17±7 and 61±14 mm Hg, respectively. At 54 days (median), 224 (44%) underwent invasive mitral procedure. At 6±4 years, 76 (15%) died. On survival analysis, primary nonrheumatic MS (hazard ratio [HR], 4.92), higher Society of Thoracic Surgeons score (HR, 1.92), lower % age-sex predicted metabolic equivalents (HR, 1.22), and higher peak-stress right ventricular systolic pressure (HR, 1.35), was associated with higher mortality, while invasive mitral procedures were associated with improved survival (HR, 0.67; all P<0.01).Conclusions:In asymptomatic patients (or with atypical symptoms) with significant MS undergoing treadmill stress echocardiography, higher mortality was associated with primary nonrheumatic MS, lower % age-sex predicted metabolic equivalents, and higher peak-stress right ventricular systolic pressure, while invasive MV procedures were associated with survival.

中文翻译：

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跑步机应力超声心动图检查发现当代二尖瓣狭窄明显的患者群体的特征和结果

背景：在当代怀疑患有严重二尖瓣狭窄（MS）的患者接受休息和跑步机压力超声心动图检查的过程中，我们评估了与长期生存相关的特征和因素。方法：我们研究了515例连续患者（无症状/非典型症状，平均左心室射血分数） 58±2％；男性43％，怀疑至少为中度MS（[1]天然二尖瓣[MV]：静息平均MV梯度≥5mm Hg或面积≤1.5cm ²[2]人工瓣膜：静息平均MV梯度≥5mm Hg或有效孔口面积≤2cm），在1/2003至12/2013之间接受了静息和跑步机应力超声心动图检查。MS分为风湿性（n = 170，33％），手术后（二尖瓣修复/置换前，n = 245，48％）和原发性非风湿性（n = 100，19％）。主要结果是全因死亡率。结果：平均静息MV梯度和右心室收缩压分别为8.5±3和39±13 mm Hg。患者达到了95±29％的性别预测代谢当量；峰值应力MV梯度和右心室收缩压分别为17±7和61±14 mm Hg。在第54天（中位数），有224例（44％）接受了有创二尖瓣手术。6±4岁时，有76（15％）人死亡。在生存分析上，原发性非风湿性MS（危险比[HR]，4.92），较高的胸外科医师学会评分（HR，1.92），P <0.01）。结论：在无症状患者（或具有非典型症状）的重大MS接受跑步机压力超声心动图检查时，原发性非风湿性MS死亡率较高，年龄性别预测的代谢当量百分比降低，右心室收缩峰值压力较高压力，而侵入性MV程序与生存率相关。